Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly... more Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly elucidated. Objective To compare structural differences of the knee in those who have sustained an acute first-time patellar dislocation resulting in a medial patellofemoral ligament (MPFL) tear by sex and age (≤17 years old, ≥18 years old). Design Case series. Setting Retrospective magnetic resonance imaging analysis. Patients or Other Participants Thirty-five acute first-time patellar dislocators with an associated MPFL tear. Main Outcome Measure(s) Patellar height using 3 methods, patellar alignment using congruency angles, and trochlear morphology using the sulcus angle. We compared the means of these variables by sex and age. The intraclass correlation coefficient was then calculated to assess the agreement of the independent reviewers. Results A total of 21 left and 14 right knees were analyzed. The MPFL tear location did not differ by sex (P = .34) or age (P = .43). Patellar heig...
To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention... more To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics. A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment. Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP. Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6-12 months after enrollment (OR = 1.70; 95% CI = 1.29-2.25; p < .001) when compared with the no-DPP group. Diabetes Prevention Program-based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.
IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary c... more IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation ...
IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause... more IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause of death in patients with cancer overall. Exercise intervention studies in patients with lung cancer have consistently shown benefits with respect to physical and emotional functioning. However, to date, exercise training has not been consistently implemented into clinical practice given that interventions have been costly and not aligned with clinical care.Methods/designThe Precision-Exercise-Prescription (PEP) study is a prospective randomised controlled trial comparing the effectiveness and feasibility of a personalised intervention exercise programme among patients with lung cancer undergoing surgery. Two-hundred patients who are diagnosed with stage primary or secondary lung cancer and are eligible to undergo surgical treatment at Huntsman Cancer Institute comprise the target population. Patients are randomised to either the (1) outpatient precision-exercise intervention group or (...
Cancer disparities in rural and frontier communities are an important issue in Utah because much ... more Cancer disparities in rural and frontier communities are an important issue in Utah because much of Utah is sparsely populated. The aims of this study were to investigate whether there are differences in the cancer incidence and 5-year survival rates in Utah by metropolitan/rural residence and to investigate disparities in distributions of cancer risk factors. We used cancer registry records to identify patients diagnosed with a first primary cancer in Utah between 2004 and 2008. We estimated 5-year survival and incidence rates. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for the risk of death. There were 32,498 (86.9%) patients with cancer who lived in metropolitan counties and 4906 (13.1%) patients with cancer who lived in rural counties at the time of cancer diagnosis. Patients with cancer from rural counties were more likely to be older, American Indian/Alaskan Native, non-Hispanic, male, and diagnosed at higher stage. Rural residents had a five-y...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Dec 1, 2017
Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a ... more Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a young population, has high survival, and is one of the most common cancers in people under age 40. The aim of this study was to examine the risks of aging-related diseases in a statewide sample of thyroid cancer survivors who were diagnosed <40 years compared with those diagnosed ≥40 and a cancer-free sample.Methods: Thyroid cancer survivors diagnosed 1997 to 2012 were matched to up to 5 cancer-free individuals on birth year, sex, birth state, using the statewide Utah Population Database. Medical records were used to identify disease diagnoses stratified over three time periods: 1 to 5, >5 to 10, and 10+ years after cancer diagnosis. Cox proportional hazards models were used to estimate hazard ratios with adjustment on matching factors, race, body mass index, and Charlson Comorbidity Index.Results: There were 3,706 thyroid cancer survivors and 15,587 matched cancer-free individuals...
Evaluation of interventions can help to close the gap between research and practice but seldom ta... more 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). 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. Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4...
To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and uncon... more 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. 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. 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 gl...
To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outp... more To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders. Retrospective analysis of a large, national, administrative US claims database. The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment. There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voi...
Medicaid insures an increasing proportion of adults in the United States. Physical therapy utiliz... more Medicaid insures an increasing proportion of adults in the United States. Physical therapy utilization for LBP in this population has not been described. Examine physical therapy utilization for Medicaid enrollees with new LBP consultations and evaluate associations with future healthcare utilization and LBP-related costs. Retrospective evaluation of claims data METHODS: We identified 2,289 individuals with new LBP consultations during 2012 (age = 39.3 years (+11.9), 68.2% female). The setting in which the patient entered care was and co-morbid conditions were identified. We examined a year after entry and categorized physical therapy utilization as 1) entry setting, 2) early (within 14 days of entry), or 3) delayed (>14 days after entry). We evaluated the year follow-up period for utilization outcomes (imaging, injections, surgery, emergency department (ED) visit) and LBP-related costs . Variables associated with physical therapy, utilization and cost outcomes were evaluated usi...
To determine the type, frequency, and factors associated with voice disorders in the elderly. Ret... more To determine the type, frequency, and factors associated with voice disorders in the elderly. Retrospective analysis of data from a large national administrative US claims database. Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses. Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65-105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosi...
Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiov... more Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiovascular (CV) events among "healthy subjects." Methods. This retrospective cohort study used the GE Centricity EMR database. "Healthy subjects" were defined as those with Charlson Comorbidity Index (CCI) score = 0 and Chronic Disease Score (CDS) = 0 at baseline. Subjects were followed for 3 years post the first date of a clinical encounter between the patient and provider. Those aged ≥18 years old with baseline HR and ≥2 post-index HR readings were identified between 01/01/1996 to 03/30/2007. Results. There were 93,952 "healthy subjects" at baseline (median age 42 years; 67.2% women; mean HR was 75.8 (SD: 11) bpm); 20.7% with a mean HR at baseline of 76.3 (SD: 11.3) bpm (median age 45; 63 women) experienced a CV event during 3 years of follow-up. The mean HR was higher among those with a CV event (76.3 bmp) compared to those without a CV event (75.7 bpm). A C...
We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosi... more We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosis and treatment in patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative U.S. claims database. Patients included were identified with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, from January 1, 2004, to December 31, 2008, and had been seen by an otolaryngologist as an outpatient and had a specialty voice evaluation designated by videolaryngostroboscopy (VLS) within 90 days of the last laryngoscopy. Patient diagnosis at the last laryngoscopy visit and the subsequent initial VLS visit were collected. Specific treatment modalities were tabulated for the 30-day period after the last laryngoscopy and for 30 days after the VLS. A total of 168,444 unique patients saw an otolaryngologist for 273,616 outpatient visits. Of those, 6.1% had a VLS performed, of which 4,000 (23.8%) oc...
Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly... more Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly elucidated. Objective To compare structural differences of the knee in those who have sustained an acute first-time patellar dislocation resulting in a medial patellofemoral ligament (MPFL) tear by sex and age (≤17 years old, ≥18 years old). Design Case series. Setting Retrospective magnetic resonance imaging analysis. Patients or Other Participants Thirty-five acute first-time patellar dislocators with an associated MPFL tear. Main Outcome Measure(s) Patellar height using 3 methods, patellar alignment using congruency angles, and trochlear morphology using the sulcus angle. We compared the means of these variables by sex and age. The intraclass correlation coefficient was then calculated to assess the agreement of the independent reviewers. Results A total of 21 left and 14 right knees were analyzed. The MPFL tear location did not differ by sex (P = .34) or age (P = .43). Patellar heig...
To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention... more To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics. A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment. Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP. Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6-12 months after enrollment (OR = 1.70; 95% CI = 1.29-2.25; p &amp;amp;amp;amp;lt; .001) when compared with the no-DPP group. Diabetes Prevention Program-based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.
IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary c... more IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation ...
IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause... more IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause of death in patients with cancer overall. Exercise intervention studies in patients with lung cancer have consistently shown benefits with respect to physical and emotional functioning. However, to date, exercise training has not been consistently implemented into clinical practice given that interventions have been costly and not aligned with clinical care.Methods/designThe Precision-Exercise-Prescription (PEP) study is a prospective randomised controlled trial comparing the effectiveness and feasibility of a personalised intervention exercise programme among patients with lung cancer undergoing surgery. Two-hundred patients who are diagnosed with stage primary or secondary lung cancer and are eligible to undergo surgical treatment at Huntsman Cancer Institute comprise the target population. Patients are randomised to either the (1) outpatient precision-exercise intervention group or (...
Cancer disparities in rural and frontier communities are an important issue in Utah because much ... more Cancer disparities in rural and frontier communities are an important issue in Utah because much of Utah is sparsely populated. The aims of this study were to investigate whether there are differences in the cancer incidence and 5-year survival rates in Utah by metropolitan/rural residence and to investigate disparities in distributions of cancer risk factors. We used cancer registry records to identify patients diagnosed with a first primary cancer in Utah between 2004 and 2008. We estimated 5-year survival and incidence rates. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for the risk of death. There were 32,498 (86.9%) patients with cancer who lived in metropolitan counties and 4906 (13.1%) patients with cancer who lived in rural counties at the time of cancer diagnosis. Patients with cancer from rural counties were more likely to be older, American Indian/Alaskan Native, non-Hispanic, male, and diagnosed at higher stage. Rural residents had a five-y...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Dec 1, 2017
Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a ... more Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a young population, has high survival, and is one of the most common cancers in people under age 40. The aim of this study was to examine the risks of aging-related diseases in a statewide sample of thyroid cancer survivors who were diagnosed <40 years compared with those diagnosed ≥40 and a cancer-free sample.Methods: Thyroid cancer survivors diagnosed 1997 to 2012 were matched to up to 5 cancer-free individuals on birth year, sex, birth state, using the statewide Utah Population Database. Medical records were used to identify disease diagnoses stratified over three time periods: 1 to 5, >5 to 10, and 10+ years after cancer diagnosis. Cox proportional hazards models were used to estimate hazard ratios with adjustment on matching factors, race, body mass index, and Charlson Comorbidity Index.Results: There were 3,706 thyroid cancer survivors and 15,587 matched cancer-free individuals...
Evaluation of interventions can help to close the gap between research and practice but seldom ta... more 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). 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. Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4...
To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and uncon... more 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. 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. 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 gl...
To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outp... more To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders. Retrospective analysis of a large, national, administrative US claims database. The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment. There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voi...
Medicaid insures an increasing proportion of adults in the United States. Physical therapy utiliz... more Medicaid insures an increasing proportion of adults in the United States. Physical therapy utilization for LBP in this population has not been described. Examine physical therapy utilization for Medicaid enrollees with new LBP consultations and evaluate associations with future healthcare utilization and LBP-related costs. Retrospective evaluation of claims data METHODS: We identified 2,289 individuals with new LBP consultations during 2012 (age = 39.3 years (+11.9), 68.2% female). The setting in which the patient entered care was and co-morbid conditions were identified. We examined a year after entry and categorized physical therapy utilization as 1) entry setting, 2) early (within 14 days of entry), or 3) delayed (>14 days after entry). We evaluated the year follow-up period for utilization outcomes (imaging, injections, surgery, emergency department (ED) visit) and LBP-related costs . Variables associated with physical therapy, utilization and cost outcomes were evaluated usi...
To determine the type, frequency, and factors associated with voice disorders in the elderly. Ret... more To determine the type, frequency, and factors associated with voice disorders in the elderly. Retrospective analysis of data from a large national administrative US claims database. Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses. Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65-105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosi...
Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiov... more Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiovascular (CV) events among "healthy subjects." Methods. This retrospective cohort study used the GE Centricity EMR database. "Healthy subjects" were defined as those with Charlson Comorbidity Index (CCI) score = 0 and Chronic Disease Score (CDS) = 0 at baseline. Subjects were followed for 3 years post the first date of a clinical encounter between the patient and provider. Those aged ≥18 years old with baseline HR and ≥2 post-index HR readings were identified between 01/01/1996 to 03/30/2007. Results. There were 93,952 "healthy subjects" at baseline (median age 42 years; 67.2% women; mean HR was 75.8 (SD: 11) bpm); 20.7% with a mean HR at baseline of 76.3 (SD: 11.3) bpm (median age 45; 63 women) experienced a CV event during 3 years of follow-up. The mean HR was higher among those with a CV event (76.3 bmp) compared to those without a CV event (75.7 bpm). A C...
We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosi... more We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosis and treatment in patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative U.S. claims database. Patients included were identified with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, from January 1, 2004, to December 31, 2008, and had been seen by an otolaryngologist as an outpatient and had a specialty voice evaluation designated by videolaryngostroboscopy (VLS) within 90 days of the last laryngoscopy. Patient diagnosis at the last laryngoscopy visit and the subsequent initial VLS visit were collected. Specific treatment modalities were tabulated for the 30-day period after the last laryngoscopy and for 30 days after the VLS. A total of 168,444 unique patients saw an otolaryngologist for 273,616 outpatient visits. Of those, 6.1% had a VLS performed, of which 4,000 (23.8%) oc...
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