Endoscopist adenoma detection rates (ADR) vary widely and are associated with patients' risk of post-colonoscopy colorectal cancers (PCCRC). However, few scalable physician-directed interventions ...demonstrably both improve ADR and reduce PCCRC risk.
Among patients undergoing colonoscopy, we evaluated a scalable online training's influence on individual-level ADRs and PCCRC risk. The intervention was a 30-minute, interactive, online training, developed using behavior-change theory to address factors that potentially impede adenoma detection. Analyses included interrupted time series analyses for pre- vs. post-training individual-physician ADR changes (adjusted for temporal trends) and Cox regression for associations between ADR changes and patients' PCCRC risk.
Across 21 endoscopy centers and all 86 eligible endoscopists, ADRs increased immediately by an absolute 3.13% (95% confidence interval CI; 1.31-4.94) in the 3-month quarter following training compared with 0.58%/quarter (95%CI: 0.40-0.77) and 0.33%/quarter (95%CI: 0.16-0.49) in the 3-year pre- and post-training periods, respectively. Post-training ADR increases were higher among endoscopists with pre-training ADRs below the median. Among 146,786 post-training colonoscopies (all indications), each 1% absolute increase in screening ADR post-training was associated with a 4% decrease in their patients' PCCRC risk (hazard ratio HR: 0.96, 95%CI: 0.93-0.99). An ADR increase of ≥10% vs. <1% was associated with a 55% reduced risk of PCCRC (HR: 0.45, 95%CI: 0.24-0.82).
A scalable online behavior-change training focused on modifiable factors was associated with significant and sustained improvements in ADR, particularly among endoscopists with lower ADRs. These ADR changes were associated with substantial reductions in their patients' risk of PCCRC.
Background/Aims: Population-based registry studies have found increases in lung, kidney, skin and thyroid cancers among organ transplant recipients compared with the general population. These studies ...link data from national transplant services and state cancer registries, thereby limiting the ability to describe recommended health care utilization, including preventive services (e.g. influenza vaccinations) and outpatient visits (9 within transplant year), and incident diagnoses of hypertension and diabetes (estimated to be 50% and 18%, respectively). The goal of this study was to characterize health care utilization and cancer incidence among solid organ transplant recipients in Kaiser Permanente Southern California (KPSC).
Methods: KPSC transplant registry data was linked to electronic medical records on solid organ transplants from 1990 to 2014. Data was stratified by kidney, liver, heart and lung transplants.
Results: Among 4,336 transplant recipients, 62% (2,703/4,336) were white, 80% (3,621/4,336) were > 35 years old, 27% (1,158/4,336) were past smokers and the mean membership length was 5.6 years. Past smoking was highest for lung transplant recipients (34%, 63/185) and liver transplant recipients (33%, 418/1,271). Survival among all transplant recipients was 89% at 2 years posttransplant yet decreased to 65% at 10 years, with the lowest survival among lung recipients (35% at 10 years). Within the first year posttransplant, recipients had a mean number of 5 primary care visits, 7 nephrology visits and 2 visits each for dermatology, urology, and obstetrics and gynecology (women). Influenza vaccination rates have increased over time and were as high as 96% among lung recipients during the 2014-2015 influenza season. Roughly, 12% (322/2,601) and 14% (151/1,082) of transplant recipients had an incident diagnosis of hypertension and diabetes. Finally, there was increased risk of all cancers excluding nonmelanoma skin cancer (standardized incidence ratio: 2.15, 95% confidence interval: 1.932.39), with the largest incidence for non-Hodgkins lymphoma, lung cancer and kidney cancer.
Conclusion: Transplant recipients in KPSC met the recommended number of outpatient visits, including specialty care visits, within the first year posttransplant. Incidences of hypertension and diabetes were lower than expected, and influenza vaccination rates were high. There was a twofold increase in cancer incidence among the solid organ transplant population.
Background/Aims: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening allows for early detection of CRC or its precursors, and leads to a decrease ...in CRC incidence and mortality. National guidelines recommend screening with either an annual fecal immunochemical test (FIT), a colonoscopy every 10 years, or a flexible sigmoidoscopy every 5 years for individuals age 5075 years. Nationally, the overall age-adjusted combined CRC screening rates increased from 52.3% to 65.4% between 2002 and 2010; however, screening rates among Asian Americans were 11% lower compared with whites, but differences among Asian subgroups is unknown. Thus, we examined CRC screening rates among Asian subgroups in a large managed care setting.
Methods: We used electronic data to characterize CRC screening among Asian subgroups (Japanese, Korean, Filipino, Asian-Indian, Chinese, Vietnamese, Other Asian) compared with white non-Hispanics (WNHs). Using descriptive and multivariable models, we evaluated 408,242 screening-eligible members of Kaiser Permanente Southern California aged 5089 years as of January 1, 2010.
Results: Compared with WNHs over the past 3 years, Japanese were least likely and Koreans were most likely to have had any CRC screening exam (odds ratio OR 0.89, 95% confidence interval CI 0.840.95; and OR 1.84, 95% CI 1.682.02, respectively). Of those screened, compared with WNHs, Japanese men were older (mean age 65.2 vs. 62.6). Screened Asian-Indians and Vietnamese had an equal distribution of men and women, while the other subgroups had more females. In the previous 3 years, Japanese were less likely to have had a FIT (41%, 1,742 of 4,301), and Vietnamese were more likely (56%, 2,248 of 4,018). In the previous 10 years, Koreans were more likely to have had a colonoscopy (56%, 1,797 of 3,189) and Filipinos were least likely (42%, 9,135 of 21,688).
Discussion: CRC screening rates and choice of screening test differ among Asian subgroups in an insured population. Further research is needed to understand the reasons for the differences among Asian subgroups, particularly the Japanese population.
BACKGROUND: Asian-Indians are the third largest group among Asians in the US. Between 1990 and 2000, the Asian-Indian population in California doubled in size from 93,557 to 200,633. Cardiovascular ...disease (CVD) rates are substantially higher in Asian-Indians compared to other racial/ethnic groups. The purpose of this study is to evaluate lifestyle CVD risk factor differences between Asian-Indian and white, non-Hispanic (WNH) men. Subjects are participants in the California Men's Health Study (CMHS), a multiethnic cohort of 84,170 men 45-69 years of age enrolled in Kaiser Permanente Southern and Northern California at baseline (2001-02). METHODS: A mailed survey collected demographic and lifestyle characteristics. Descriptive analyses and multivariable logistic regression, adjusting for demographics, were performed to evaluate the survey data. RESULTS: The CMHS cohort is comprised of WNH (62%, 51,909/84,170), 14% (11,407/84,170) Hispanic, 8% (6,298/84,170) African-American, 11% (8,705/84,170) Asian/Pacific Islander, and 5% (6,733/84,170) other/mixed men. Of the 8,705 Asian/Pacific Islanders, 602 identified themselves as Asian-Indian. Although most Asian-Indian men were first generation immigrants (94%, 568/602), over three-fourths had resided in the US for 16+ years. Age distribution did not differ between Asian-Indian and WNH men. Asian-Indians were more likely than WNHs to live in a low income household (22%, 134/602 vs. 15%, 7,963/51,901), yet had considerably higher educational attainment (77% v 53%, with college degree). Asian-Indian men more often reported a healthy BMI (18.5-24.9) Adjusted Odds Ratio (AOR) = 1.83 (95% CI 1.54-2.18) and more often consumed <30% calories from fat AOR = 2.57 (95% CI 2.13-3.11). There were no differences for fruit and vegetable consumption; however, Asian-Indian men were more likely to have never smoked and to abstain from alcohol. While Asian-Indian men were less likely to report moderate/vigorous physical activity > 3.5 hours/week AOR = 0.54 (95% CI 0.46-0.64), there was little difference in sedentary activity time spent outside of work. CONCLUSION: Despite a higher prevalence of CVD among Asian Indian men, in the CMHS we found Asian-Indian men had fewer CVD-related lifestyle risk factors. These results suggest risk factors other than lifestyle behaviors may be major contributors to CVD in the Asian Indian population.
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