The Permanente journal最新文献

{"title":"Erratum to <i>Latissimus Dorsi</i> Tendon Repair Through Single-Incision Axillary Approach Using All-Suture Anchor Tension Slide.","authors":"","doi":"10.7812/TPP/25.085","DOIUrl":"https://doi.org/10.7812/TPP/25.085","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Health Care Utilization of Posttraumatic Stress Disorder and Other Trauma-Related Mental Health Diagnoses in a Large, Integrated Health Care System.","authors":"Barney R Vaughan, Yun Lu, Natalie E Slama, Monique B Does, Matthew E Hirschtritt, Kathryn K Ridout, Maria T Koshy, Kelly C Young-Wolff","doi":"10.7812/TPP/24.191","DOIUrl":"https://doi.org/10.7812/TPP/24.191","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is often underdiagnosed based on medical records. This study aimed to estimate the prevalence and health care utilization of individuals with PTSD and other trauma-related disorders in a large, integrated health care system.</p><p><strong>Methods: </strong>Adults (between the ages of 18 and 65) with Kaiser Permanente Northern California membership and ≥ 1 outpatient visit in 2022 were eligible. Unspecified/other specified trauma and stressor-related disorder, acute stress disorder, and PTSD were based on diagnosis codes from the International Classification of Diseases, 10th Revision, Clinical Modification. The Primary Care PTSD (PC-PTSD) Scale was used as a screening tool. Prevalence was assessed overall and among the subset of patients seen in primary care, psychiatry, and addiction medicine. To contextualize health care utilization, the authors compared patients with trauma-related disorders to those with major depressive disorder.</p><p><strong>Results: </strong>Of the 2,128,670 eligible adults, the overall prevalence of trauma-related diagnoses and positive screening on PC-PTSD was 4.9% (103,947); 1.3% (n = 27,670) had PTSD, 1.9% (n = 41,205) had unspecified/other specified trauma and stressor-related disorder, 0.1% (n = 1818) had acute stress disorder, and 1.6% (n = 33,254) screened positive on PC-PTSD without a trauma-related International Classification of Diseases code. Prevalence of trauma-related diagnoses by department was 18.3% (n = 47,516) in psychiatry, 16.5% (n = 3816) in addiction medicine, and 3.4% (n = 67,469) in primary care. There were no clinically meaningful differences in health care utilization between those with trauma-related diagnoses compared with major depressive disorder.</p><p><strong>Conclusion: </strong>Broadly defining trauma-related disorders and substantial symptoms may provide a more accurate representation of the actual prevalence of PTSD in a health care system. These data may help health care leaders plan treatment options for this diverse group of individuals.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call for Papers: Advancing the Health in Our Communities With Value-Based Care.","authors":"","doi":"10.7812/TPP/25.066","DOIUrl":"https://doi.org/10.7812/TPP/25.066","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking Risk Factors for Post-COVID-19 Olfactory Dysfunction Resulting From Early Stages of the Pandemic: A Case-Control Study of Lost and Lingering Smells.","authors":"Brooke Stephanian, Jacob Hoerter, Julia Wei, Richard Pellizzari, Jonathan Liang","doi":"10.7812/TPP/25.010","DOIUrl":"https://doi.org/10.7812/TPP/25.010","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic has highlighted olfactory dysfunction (OD) as a major and often persistent symptom in affected individuals. Thus, it is important to identify demographic and clinical factors contributing to OD among patients with COVID-19.</p><p><strong>Methods: </strong>A case-control (1:3) study was performed in adult patients with COVID-19 diagnosis between July 2020 and June 2021. Cases had OD; controls did not have OD. OD was subclassified as acute smell loss (< 3 months), chronic smell loss (> 3 months), or altered sense of smell (eg, parosmia, phantosmia). Bivariate tests and multivariable logistic regression were performed for analysis.</p><p><strong>Results: </strong>Of the 4220 patients that met criteria, 1055 (25%) had OD. Of those with OD, 650 (61.6%) had acute smell reduction, 350 (33.2%) had chronic smell reduction, and 245 (23.2%) had altered sense of smell. Older (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.79-0.89), male (OR, 0.62; 95% CI, 0.54-0.72), and Asian (OR 0.75; 95% CI, 0.59-0.95) patients were less likely to experience OD. Having seasonal allergies (OR, 1.44; 95% CI, 1.11-1.86) and being hospitalized (OR, 1.52; 95% CI, 1.14-2.02) increased the likelihood of OD development. Compared with acute loss, chronic smell loss was likelier in older, female, non-White, hospitalized, and cerebrovascular disease patients (<i>P</i> < .05).</p><p><strong>Discussion: </strong>Understanding the course of post-COVID-19 OD is becoming increasingly important and may broaden these insights.</p><p><strong>Conclusion: </strong>Being younger, female, and atopic conferred highest likelihood of OD development after COVID-19.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of Corticosteroid Is Associated With the Possibility of Subsequent Surgery for Trigger Finger: A Retrospective Cohort Study.","authors":"Todd A Theman, Bradley Frueh, Brandon Horton, Lawrence Cai, Julie A Schmittdiel","doi":"10.7812/TPP/24.151","DOIUrl":"https://doi.org/10.7812/TPP/24.151","url":null,"abstract":"<p><strong>Introduction: </strong>Trigger finger is one of the most common conditions treated by hand surgeons. Although corticosteroid injection is a common first-line treatment, there is no consensus regarding the most effective type of steroid.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study of patients with a diagnosis of trigger finger within Kaiser Permanente Northern California, a large, community-based, integrated health system with a comprehensive electronic medical record. Patients were potentially exposed to 4 different steroid regimens: betamethasone, dexamethasone, methylprednisolone, and triamcinolone. The primary outcome was the possibility of subsequent trigger finger surgery following initial corticosteroid treatment.</p><p><strong>Results: </strong>Among 20,141 patients with an injection for trigger finger diagnosis, 1668 (8.3%) had a trigger finger release procedure following injection. Compared with patients injected with triamcinolone, dexamethasone patients had a hazard ratio of 4.12 for surgery (95% confidence interval [CI], 3.06-5.54), betamethasone patients had a hazard ratio of 2.40 (95% CI, 1.86-3.10), and methylprednisolone had a hazard ratio of 1.77 (95% CI, 1.32-2.37).</p><p><strong>Discussion: </strong>This large, retrospective observational study suggests that the type of corticosteroid used for trigger finger may influence the possibility of subsequent surgery.</p><p><strong>Conclusions: </strong>This information may inform corticosteroid choice for treating trigger finger, but findings should be confirmed in a prospective study.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Latissimus Dorsi</i> Tendon Repair Through Single-Incision Axillary Approach Using All-Suture Anchor Tension Slide.","authors":"Andrew Zogby, Daniel Hagaman, Brittany M Woodall, Brianna Caraet, Najeeb Khan","doi":"10.7812/TPP/24.200","DOIUrl":"10.7812/TPP/24.200","url":null,"abstract":"<p><p>This case report and technical note details the successful surgical repair of a <i>latissimus dorsi</i> (LD) tendon rupture in a high-demand athlete using a single-incision axillary approach with an all-suture anchor tension slide technique. The patient, a 38-year-old competitive athlete, sustained the injury during a Spartan Race, presenting with substantial functional limitations, including shoulder weakness and impaired performance in athletic and professional activities. Clinical and imaging findings confirmed a complete LD tendon rupture with 6 cm of retraction and associated teres major partial tearing. Surgical repair involved tendon mobilization, preparation of the humeral footprint, and fixation with all-suture anchors in a tension slide configuration. Postoperatively, the patient underwent a tailored rehabilitation protocol, achieving near-complete return to preinjury function by 7 months. This innovative technique offered advantages, including cosmetic incision, minimized surgical morbidity, and familiarity with sports surgeons' techniques. The all-suture anchors avoid metal implants, reduce bone loss, and simplify the procedure compared to cortical buttons. Although effective, the approach requires technical expertise, particularly in mitigating neurovascular risks. This report underscores the efficacy and reproducibility of this method in treating LD tendon ruptures in high-demand athletes. Further biomechanical and clinical comparisons are warranted to refine surgical indications and optimize outcomes.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Psychiatric Concerns in a Veteran Reporting Gulf War Illness: A Case Report.","authors":"Christian Alan Botz-Zapp, Jami Wang, Eric Kazangian, Jennifer Ferrer","doi":"10.7812/TPP/24.071","DOIUrl":"https://doi.org/10.7812/TPP/24.071","url":null,"abstract":"<p><p>Gulf War illness (GWI) is a chronic condition affecting nearly a third of Gulf War veterans and is characterized by persistent symptoms across a number of physical and neuropsychiatric domains. This case study examined a 52-year-old veteran admitted on a psychiatric hold for danger to others. The patient's symptoms, including chronic migraine, widespread musculoskeletal pain, skin sensitivities, environmental allergies, and mood and cognitive disturbances, met criteria for GWI according to 2 accepted case definitions. Initial misdiagnosis of psychosis was corrected upon evaluation, which identified severe anxiety consistent with generalized anxiety disorder. Treatment focused on providing validation of the patient's chronic symptoms and managing his anxiety through pharmacologic intervention. This case underscored the importance of recognizing GWI to ensure accurate diagnoses and targeted care for veterans.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Techniques to Estimate the Sensitivity of the Agency for Healthcare Research and Quality Patient Safety Indicators.","authors":"Daniel J Tancredi, Patricia A Zrelak, Garth H Utter, Jeffrey J Geppert, Patrick S Romano","doi":"10.7812/TPP/24.180","DOIUrl":"https://doi.org/10.7812/TPP/24.180","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how comprehensively the Agency for Healthcare Research and Quality's patient safety indicators (PSIs) capture true complications. Therefore, the authors sought to assess the PSIs' sensitivity using a novel sampling and analytic strategy tailored for unusual events to ensure adequate capture of false negative cases.</p><p><strong>Methods: </strong>The authors retrospectively reviewed hospitalization records not flagged by 7 selected PSIs, oversampling those with specific diagnosis or procedure codes suggesting an unreported complication, with a special interest in PSI 09 (Postoperative Hemorrhage or Hematoma) and PSI 10 (Postoperative Physiologic and Metabolic Derangement). The authors evaluated data from 27 hospitals in 11 states between 2006 and 2009. For each PSI, the authors determined the negative predictive value (NPV), accounting for sampling weights, and used previous estimates of positive predictive value (PPV) and incidence to estimate sensitivity.</p><p><strong>Results: </strong>For PSI 09, 32 of 281 abstracted records (including 30 of 116 high-risk records) were falsely negative (NPV 99.73%; 97.5%, confidence interval [CI], 98.96-99.94); the estimated sensitivity was 40% (95% CI, 12-76). For PSI 10, 3 of 230 records (including 3 of 108 high-risk records) were falsely negative (NPV 99.92%; 97.5% CI, 99.28-99.99); the sensitivity was 53% (95% CI, 9-92). The estimated sensitivity of other PSIs varied (19%-100%).</p><p><strong>Conclusions: </strong>The sensitivity of several Agency for Healthcare Research and Quality PSIs, estimated from a sample of hospitalizations enriched with records suggesting an unreported complication, varied widely. Although the 2-stage complex stratified sampling design (using weights based on sampling probabilities) allows estimation of the sensitivity of hospital outcome measures, large sample sizes are still required for unusual events.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Humanistic Approach to Improvement: The Multiple Sclerosis Continuous Quality Improvement Collaborative Coaching Approach.","authors":"Randall Scott Messier, Brant J Oliver","doi":"10.7812/TPP/24.054","DOIUrl":"https://doi.org/10.7812/TPP/24.054","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a costly, chronic, complex condition, which requires customization of care at the system level to achieve better outcomes. The authors describe a cluster-randomized, coach-supported quality improvement (QI) intervention in the MS continuous QI (MS-CQI) Collaborative, which was a multicenter learning health system (LHS) study to improve MS outcomes (2018-2022).</p><p><strong>Methods: </strong>The authors developed a coach-supported QI intervention within the MS-CQI LHS, which included aspects of standard QI approaches utilized in health care. This included a 12-step standardized QI Toolkit; team coaching twice monthly; team capability assessments; and patient-reported and clinical feedback data provided by the MS-CQI data registry. Assessments helped the coach understand clinic culture, readiness for change, QI skills and knowledge, and progress over time. The coach monitored and guided team activity and assured general adherence to the 12-step improvement process. Teams selected local QI activities within those constraints.</p><p><strong>Results: </strong>A total of 3 out of the 4 MS-CQI centers were cluster randomized to the intervention and completed the study. Initial QI assessments revealed that teams perceived QI as important but had low initial skill and knowledge levels. Improved QI skills, knowledge, and engagement in the intervention improved, as teams realized ownership and perceived benefits.</p><p><strong>Conclusions: </strong>The coach-supported QI intervention demonstrated basic feasibility, acceptability, QI skill advancement, and utility in the MS-CQI study. It is an example of an LHS-enabled humanistic (QI team-focused) intervention, which invests in developing capability of people involved in QI work.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Models of Care in Hospital Medicine: An Analysis of Advance Practitioner Utilization Using Monte Carlo Methods.","authors":"Rohit Sharma, Noora Akram, Michael Madden","doi":"10.7812/TPP/24.159","DOIUrl":"https://doi.org/10.7812/TPP/24.159","url":null,"abstract":"<p><strong>Introduction: </strong>Physicians are facing a constant shortage, with market estimates of shortfalls only projected to increase as the population of the United States ages and health care employment needs increase. A lack of physicians has led to a steady increase in the number and scope of advanced practice practitioners (APPs) in the United States. Nurse practitioners and physician assistants have increased, in terms of percentage of the practitioner workforce, with varying degrees of autonomy. The authors describe a model of APPs to determine whether indirect supervision vs direct supervision is fiscally optimum in hospital medicine departments.</p><p><strong>Methods: </strong>The authors utilized R software in R Studio to simulate, via Monte Carlo methods, APP-independent and supervised models of care. Publicly available salary data were used as the foundation to generate the models. The data were then used to simulate typical care teams of APPs and physicians in hospital medicine, while utilizing typical billing practices.</p><p><strong>Discussion: </strong>Analysis of the models of care generated demonstrated that APPs, given the current payer reimbursements, are an integral part of the hospital medicine care team. A range of scenarios are accounted for. This research demonstrates that direct supervision has a lower cost per work relative value unit cost to the employer, as opposed to indirect supervision.</p><p><strong>Conclusion: </strong>APPs will only continue to increase their share of billed visits. In the setting of a hospital medicine workflow, given current payer and salary constraints, direct supervision is recommended to optimize the care team from a fiduciary perspective.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}