Sociodemographic Characteristics of Members of a Large, Integrated Health Care System: Comparison with US Census Bureau Data

Koebnick, Corinna; Langer‐Gould, Annette; Gould, Michael K.; Chao, Chun; Iyer, Rajan L.; Smith, Ning; Chen, Wansu; Jacobsen, Steven J.

doi:10.7812/tpp/12-031

Cited by 689 publications

(495 citation statements)

References 17 publications

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“…A strength of our study was its large and representative patient sample [17]. Additionally, our ability to combine clinical, pharmacologic, and radiographic data for such a large sample was unique, and the capacity to link this information in our integrated healthcare system, where all patients have unique patient identifiers, minimized the bias involved with collecting and merging data from several sources.…”

Section: Discussionmentioning

confidence: 99%

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Khatod

Inacio

Dell

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described. Questions/purposes (1) Is bisphosphonate use in patients with osteoarthritis undergoing primary THA associated with a change in the risk of all-cause revision, aseptic revision, or periprosthetic fracture compared with patients not treated with bisphosphonates? (2) Does the risk of bisphosphonate use and revision and periprosthetic fracture vary by patient bone mineral density and age? Methods A retrospective cohort study of 12,878 THA recipients for the diagnosis of osteoarthritis was conducted; 17.8% of patients were bisphosphonate users. Data sources for this study included a joint replacement registry (93% voluntary participation) and electronic health records and an osteoporosis screening database with complete capture of cases as part of the Kaiser Permanente integrated healthcare system. The endpoints for this study were revision surgery for any cause, aseptic revision, and periprosthetic fracture. The exposure of interest was bisphosphonate use; patients were considered users if prescriptions were continuously refilled for a period equal to or longer than 6 months. Bone quality (based on dual-energy x-ray absorptiometery ordered based on the National Osteoporosis Foundation's clinical guidelines taken within 5 years of the THA) and patient age (\ 65 versus C 65 years) were evaluated as effect modifiers. Patient, surgeon, and hospital factors were evaluated as confounders. Cox proportional hazards models were used. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined. Results Age-and sex-adjusted risks of all-cause (HR, 0.50; 95% CI, 0.33-0.74; p \ 0.001) and aseptic revision Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. HR, 0.53; 95% CI,; p = 0.004) was lower in bisphosphonate users than in nonusers. The adjusted risk of periprosthetic fractures in patients o...

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Section: Discussionmentioning

confidence: 99%

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Khatod

Inacio

Dell

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Since the revision risk calculators were based on available data from our integrated healthcare system, generalizability beyond our healthcare system has not been established and is a limitation of the study. However, our patient membership has been shown to reflect the sociodemographic makeup of the entire corresponding census region population for large regional subsets [23]. More extensive validation outside the integrated healthcare system is still necessary to ensure generalizability of these revision risk calculators.…”

Section: Discussionmentioning

confidence: 99%

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

Paxton

Inacio

Khatod³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Considering the cost and risk associated with revision Total knee arthroplasty (TKAs) and Total hip arthroplasty (THAs), steps to prevent these operations will help patients and reduce healthcare costs. Revision risk calculators for patients may reduce revision surgery by supporting clinical decision-making at the point of care. Questions/purposes We sought to develop a TKA and THA revision risk calculator using data from a large health-maintenance organization's arthroplasty registry and determine the best set of predictors for the revision risk calculator. Methods Revision risk calculators for THAs and TKAs were developed using a patient cohort from a total joint replacement registry and data from a large US integrated healthcare system. The cohort included all patients who had primary procedures performed in our healthcare system between April 2001 and July 2008 and were followed until January 2014 (TKAs, n = 41,750; THAs, n = 22,721), During the study period, 9% of patients (TKA = 3066/ 34,686; THA=1898/20,285) were lost to followup and 7% died (TKA= 2350/41,750; THA=1419/20,285). The outcome of interest was revision surgery and was defined as replacement of any component for any reason within 5 years postoperatively. Candidate predictors for the revision risk calculator were limited to preoperative patient demographics, comorbidities, and procedure diagnoses. Logistic regression models were used to identify predictors and the Hosmer-Lemeshow goodness-of-fit test and c-statistic were used to choose final models for the revision risk calculator.

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“…It includes 14 medical centers and over 200 medical office buildings. Health plan members have a demographic, racial/ethnic, and socioeconomic profile similar to the overall southern California population 18. Over 20 000 deliveries occur within KPSC hospitals every year.…”

Section: Methodsmentioning

confidence: 99%

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

Lee

Chen

Zhang

et al. 2016

JAHA

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BackgroundThe goal of this study was to determine the prevalence of atrial fibrillation and atrial flutter (AF) in pregnant women and to examine the impact of AF on maternal and fetal outcomes.Methods and ResultsBetween January 1, 2003 and December 31, 2013, there were 264 730 qualifying pregnancies (in 210 356 women) in the Kaiser Permanente Southern California hospitals, among whom AF was noted in 157 pregnancies (129 women; 61.3 per 100 000 women, or 59.3 per 100 000 pregnancies). Prevalence of AF (per 100 000 women) in white, black, Asian, and Hispanic women was 111.6, 101.7, 45.0, and 34.3, respectively. Older age was associated with higher odds of having AF. Compared to women <25 years of age, the odds ratio (OR) of AF was 4.1 in women age 30 to 34 years, 4.9 in women age 35 to 39 years, and 5.2 in women age ≥40. Odds of AF episodes were higher during the third trimester compared to the first trimester (OR, 3.2; 95% CI: 1.5–7.7). Among AF patients, adverse maternal cardiac events were rare—2 women developed heart failure and there were no strokes or systemic embolic events and no maternal death. There were 156 live births (99.4% of all pregnancies). Compared to women without AF, fetal birth weights were similar, but rate for neonates’ admission to the neonatal intensive care unit was higher (10.8% vs 5.1%; P=0.003).Conclusions AF is rare in pregnant women. Certain factors such as increased maternal age and white race increase the odds of having AF. Major maternal and fetal complications are infrequent, albeit a source of concern.

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Sociodemographic Characteristics of Members of a Large, Integrated Health Care System: Comparison with US Census Bureau Data

Cited by 689 publications

References 17 publications

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

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