The Permanente journal最新文献

{"title":"Factors Associated With Diagnosing Psoriatic Arthritis: A Retrospective Study in Northeast Georgia.","authors":"Romina Faridizad, Brent A Flickinger, Ania Izabela Rynarzewska, Sarah Ross, Shane Robinson, Aditya Kumar Ghosh","doi":"10.7812/TPP/25.025","DOIUrl":"https://doi.org/10.7812/TPP/25.025","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15.5% of patients with psoriatic arthritis (PsA) are currently not diagnosed or experience delayed diagnosis with negative outcomes. This retrospective, cross-sectional study evaluated patients with psoriasis to determine what factors were associated with diagnosis of PsA.</p><p><strong>Methods: </strong>A retrospective chart review was performed using electronic medical record from primary care clinics across the northeast Georgia region. The study population included patients with psoriasis evaluated in the clinic between January 1, 2017 and December 31, 2022. Patients with PsA were compared to those without PsA to assess for factors associated with the diagnosis of PsA.</p><p><strong>Results: </strong>The probability of diagnosis of PsA increased with increasing number of clinic encounters (odds ratio [OR], 1.18; <i>P</i> < .05). Males (OR, 0.634; <i>P</i> < .001) were less likely to be diagnosed compared to females. Patients with Medicare (adjusted OR, 1.707; 95% confidence interval [CI], 1.027-2.837; <i>P</i> < .05) and commercial/private insurances (adjusted OR, 2.043; 95% CI, 1.28-3.258; <i>P</i> < .01) had a higher chance of being diagnosed in comparison to patients with Medicaid. Black patients were less likely to be diagnosed compared to White patients (OR, 0.231; <i>P</i> < .001). Hispanic patients were less likely to be diagnosed with PsA compared to patients who were not Hispanic (OR, 0.2; 95% CI, 0.07-0.51; <i>P</i> < .05).</p><p><strong>Conclusions: </strong>The study highlighted potential factors associated with the diagnosis of PsA among patients with psoriasis. Sex, race, ethnicity, number of clinic encounters, and insurance type were all found to have associations with likelihood of receiving a PsA diagnosis. These findings were hypothesis-generating and suggest potential disparities in care, particularly for diverse populations, warranting further research.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691630","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":"Comparison of Apixaban With Warfarin in Patients on Dialysis Within an Integrated Health Care System.","authors":"Tariq Shaheed, Douglas Stram, Aida Shirazi, Sumie Iwasaki, Cynthia Davila, Sijie Zheng","doi":"10.7812/TPP/25.043","DOIUrl":"https://doi.org/10.7812/TPP/25.043","url":null,"abstract":"<p><strong>Introduction: </strong>The risk and benefit for patients on dialysis receiving anticoagulation (AC) therapy have not been clearly established. This study aimed to compare the rates of clinically significant thrombotic and bleeding events in patients on dialysis.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted using Kaiser Permanente Northern California's electronic medical record database from 2013 to 2021. Patients over 18 years old on dialysis who were prescribed warfarin or apixaban were included. Patients with mechanical valves were excluded. The outcomes were analyzed using Mann-Whitney tests for continuous variables, χ² tests for categorical variables, and Kaplan-Meier method for time-to-event analysis.</p><p><strong>Results: </strong>In the study period, 9832 patients were not on AC, and 2088 were taking apixaban or warfarin. The baseline demographics (age, Charlson Comorbidity Index, and sex) were comparable between apixaban and warfarin groups. Among the patients on anticoagulants, 181 were taking apixaban, while 1907 were taking only warfarin. The outcomes 1-3 years within the study period showed that the rates of clinically significant bleeding and thrombosis were comparable in both groups, with the exception of the rate of dialysis access thrombosis being lower in the apixaban group (7% vs 17%, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>In this diverse cohort, apixaban and warfarin showed no clinically significant differences in bleeding rates and lower rate of access thrombosis with apixaban. This study adds to the growing data of AC in the population with end-stage kidney disease, highlighting the need to enroll patients in an adequately powered randomized controlled trial to inform future practice.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683231","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":"Physician Performance in the Merit-Based Incentive Payment System: Implications for Health Disparities.","authors":"Joseph H Joo, Jubi Yl Lin, Lingmei Zhou, Danielle S Browne, Edwin S Wong, Joshua M Liao","doi":"10.7812/TPP/25.042","DOIUrl":"https://doi.org/10.7812/TPP/25.042","url":null,"abstract":"<p><strong>Introduction: </strong>The Merit-Based Incentive Payment System (MIPS) was ostensibly designed to promote better care across participants. However, MIPS risks exacerbating disparities among participants with fewer resources to invest in performance metrics like care delivery improvements or quality reporting. Unfortunately, little is known about how group practice characteristics have impacted MIPS scores and associated reimbursement over time.</p><p><strong>Methods: </strong>The analysis involved data from the MIPS Overall Clinician Performance Database, which included information about 2019 MIPS performance among all practices and clinicians. MIPS data were combined with other datasets to assess physician group practice characteristics. Additional practice- and area-level variables were obtained from the Dartmouth Atlas and the County Health Rankings file.</p><p><strong>Results: </strong>In the adjusted analysis, 2 practice-level characteristics (location in urban areas and larger patient populations) and 2 community-level characteristics (some college education and health care spending) were positively associated with MIPS scores. In contrast, patient population case mix and the proportion of Medicare/Medicaid dual-eligible patients were negatively associated with MIPS scores at the practice level.</p><p><strong>Discussion: </strong>The proportion of Medicare/Medicaid dual-eligible patients, but not the proportion of Black patients, was associated with lower MIPS scores. A number of other practice- and community-level characteristics were also associated with MIPS performance. These findings underscore the potential risk that MIPS may exacerbate health disparities by penalizing practices caring for lower-income populations adversely affected by social drivers of health.</p><p><strong>Conclusion: </strong>To address health disparities in MIPS, policymakers could consider following precedent from other payment programs and account for practice factors when evaluating MIPS performance.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643632","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":"Private Health Insurance in Taiwan: Insights From the US Medicare Program.","authors":"Joshua M Liao, Ching-Ching Claire Lin","doi":"10.7812/TPP/25.064","DOIUrl":"https://doi.org/10.7812/TPP/25.064","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620695","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":"Professional Title Use and Gender Representation During Grand Rounds and Invited Lectureships Across Specialties.","authors":"Alexandra Hernandez, Mollie C Marr, Alexandra Pincus, Karen J Brasel","doi":"10.7812/TPP/25.003","DOIUrl":"10.7812/TPP/25.003","url":null,"abstract":"<p><strong>Introduction: </strong>Studies show that women are underrepresented in grand rounds across academic specialties. When women are invited as speakers, they are less likely to be introduced by their professional title compared to men. The purpose of this study was to determine what factors influenced the use of professional titles when introducing speakers at grand rounds.</p><p><strong>Methods: </strong>This was a retrospective, observational study of grand rounds from October 2017 to March 2020 for the departments of internal medicine, neurology, OB/Gyn, pediatrics, psychiatry, and surgery at a large, academic medical center in the United States. Introductions were coded for the use of speakers' title, introducer and speaker gender, introducer and speaker training level, and speaker home institution.</p><p><strong>Results: </strong>A total of 386 unique grand rounds and invited lectureships were reviewed for a total of 717 introductions. A greater number of men spoke at grand rounds across specialties and training (55%, χ² = 450.4, <i>P</i> < .01). Men represented a greater proportion of invited speakers (62%, χ² = 13.23, <i>P</i> < .01). Overall, men and women were introduced by their professional title with similar frequency (49% women). Invited and endowed speakers were more likely to be introduced by their professional title (odds ratio, 1.85; 95% confidence interval, 1.14-3.01; <i>P</i> = .01). Title use and representation varied by specialty.</p><p><strong>Conclusions: </strong>Women remain underrepresented as grand rounds and invited speakers. Men and women were introduced by their professional title with similar frequency. Differences between departments suggested that introduction protocols increased title use, and consideration of gender balance could be used to improve gender representation.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584957","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":"Comparing Care Delivery Efficiency Between Emergency Department and Oncology Urgent Care.","authors":"Arthur S Hong, Sadaf Charania, Angela Bazzell, Mark Courtney, John W Sweetenham, Jason Fleming, Simon J Craddock Lee, Ethan A Halm","doi":"10.7812/TPP/24.195","DOIUrl":"https://doi.org/10.7812/TPP/24.195","url":null,"abstract":"<p><strong>Introduction: </strong>Adults often visit the emergency department (ED) for complications from cancer treatment. Oncology urgent care clinics (UCCs) can manage nonemergent issues, but little is known about how UCC care compares with ED care.</p><p><strong>Methods: </strong>The authors' university hospital ED and UCC visits (January 1, 2023, through June 30, 2023) were analyzed after coding the Emergency Severity Index (ESI) for UCC visits to make them comparable to ED visits, where ESI was already regularly assigned. ESI ranges from levels 1 to 5 (1 = highest severity). Coarsened exact matching and multivariate models were used to compare the proportion of patients discharged home, the length of stay, and advanced imaging use. Marginally adjusted outcomes were stratified by ESI.</p><p><strong>Results: </strong>Prior to matching, 31.7% of UCC and 64.0% of ED visits were ESI level 2 severity; 61.0% of UCC and 33.4% of ED visits were ESI level 3. Matching resulted in 1033 UCC and 2782 ED visits (61.0% of patients > age 65; 47.8% female; 65.9% non-Hispanic White). In adjusted analyses, for ESI level 2 visits, the UCC discharged patients home 32.0% more often than the ED (95% confidence interval [CI], 27.5-36.4), with a 7.0-hour shorter length of stay (95% CI, 6.5-7.5), and used advanced imaging 30.3% less often (95% CI, 26.0-34.7). Findings were similar for ESI level 3 visits.</p><p><strong>Discussion: </strong>The UCC managed a high level of severity and may be more efficient than the ED for nonemergent care.</p><p><strong>Conclusion: </strong>Future work should more broadly investigate care delivery at each site, including the cost of care.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498082","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":"Chagas Disease in Northern California: Observed Prevalence, Clinical Characteristics, and Outcomes Within an Integrated Health Care Delivery System.","authors":"Salvador Hernandez, Kishan K Srikanth, Akshay Bommireddi, Thomas K Leong, David A Miller, Andrew P Ambrosy, Jonathan Zaroff","doi":"10.7812/TPP/25.041","DOIUrl":"https://doi.org/10.7812/TPP/25.041","url":null,"abstract":"<p><strong>Introduction: </strong>Chagas disease (CD) is caused by the protozoan parasite <i>Trypanosoma cruzi</i> and can remain clinically silent for decades. The objectives of this study were to quantify the prevalence of CD within the membership of Kaiser Permanente Northern California, to describe the demographic and clinical characteristics of patients with CD, and to report their adverse cardiovascular outcomes.</p><p><strong>Methods: </strong>In this cohort study from 2006 to 2022, the authors identified patients with CD by screening the electronic medical record for International Classification of Diseases, 9th Revision and 10th Revision codes. The authors obtained demographic, medical history, electrocardiographic, echocardiographic, and pharmacy data. Adverse outcomes, including all-cause mortality, heart failure hospitalization, and heart transplantation, were identified by database programming and confirmed by manual chart review.</p><p><strong>Results: </strong>There were 53 cases of CD in total, and 75% of patients self-identified as Hispanic. The mean age was 49 years old, and 45% were female. Dyslipidemia (45%) and hypertension (32%) were common comorbidities. A total of 7 patients (13%) had a left ventricular ejection fraction < 45%. During the follow-up period, adverse outcomes included 4 cardiovascular deaths, 5 heart failure hospitalizations, and 4 heart transplantations. The prevalence of diagnosed CD in the Kaiser Permanente Northern California population has risen from 0.22 per 100,000 persons from 2006 to 2010 to 0.70 per 100,000 persons from 2018 to 2022.</p><p><strong>Discussion: </strong>The prevalence of diagnosed CD in Kaiser Permanente Northern California increased during the study period, and patients with CD frequently had poor cardiovascular outcomes, likely due to the patients presenting with advanced disease.</p><p><strong>Conclusion: </strong>Systematic screening and awareness are likely to facilitate early diagnosis and improve treatment to avoid chronic complications of CD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498026","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":"Long-Term Survivor of Laryngeal Small Cell Neuroendocrine Carcinoma.","authors":"Melisa Bayrak, Laura Wright Powers, Juliana Robledo, Jay Ferrell","doi":"10.7812/TPP/24.182","DOIUrl":"https://doi.org/10.7812/TPP/24.182","url":null,"abstract":"<p><p>Small cell neuroendocrine carcinoma (SCNC) of the larynx is an exceptionally rare subset of laryngeal carcinoma with a clinically aggressive course and poor prognosis. Long-term survival is rare, and treatment strategies remain nonstandardized due to limited data. In this report, the authors present a case of a 51-year-old male who presented with stage IVa laryngeal SCNC and no distant metastasis, treated with a combination of platinum-based chemotherapy and radiation, who has survived for more than 5 years. This case represented 1 of few reported instances of extended disease-free survival in laryngeal SCNC, highlighting the potential benefit of aggressive multimodal treatment, even in advanced-stage disease. In addition to diagnosis and management, this case may prompt further discussion about the role of surgery in select patients and the need for individualized, patient-centered survivorship care for management of posttreatment sequalae. Although limited to a single case, these findings underscore the need for further research into effective treatment and surveillance strategies for this rare malignancy.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485850","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 Hybrid Chart Review of Premature Coronary Artery Disease: An Opportunity to Improve Diagnostic Excellence and Management.","authors":"Kerry Litman, Michael H Kanter, Ali Ghobadi, Mimi Hugh, Maverick Au, Noah Contreras, Timothy S Ho, Mingsum S Lee, Albert Shen, Rabia R Razi, Ronald Scott, John Martin","doi":"10.7812/TPP/24.184","DOIUrl":"https://doi.org/10.7812/TPP/24.184","url":null,"abstract":"<p><strong>Background: </strong>Premature coronary artery disease (premCAD) and its risk factors may not always be diagnosed or treated optimally.</p><p><strong>Objective: </strong>This study reviewed a sample of patients with premCAD within an integrated health care system to identify opportunities for improved diagnosis and care.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Participants: </strong>The authors reviewed a sample of 28 patients with acute myocardial infarction before age 50.</p><p><strong>Key results: </strong>Several opportunities were found, including lack of documentation of family history of premCAD (only present in 5/28 [18%]); delays or failure to diagnose in electronic chart problem in patients with diabetes mellitus (3/15 [20%]); failure to diagnose obesity in patients with a body mass index > 30 (12/28 [43%]); and gaps in continuity of care in patients who were new members (3/28 [11%]). These findings led to several changes, including improved identification and monitoring of patients with possible diabetes mellitus and obesity; improved identification of patients with increased risk of premCAD; and improved identification of premCAD risk factors in newly enrolled members.</p><p><strong>Conclusions: </strong>This study highlights the value of a systematic approach to identifying variability and in developing tailored strategies to improve the diagnosis and management of premCAD and reduce future incidence. This approach can be used in other settings and conditions to identify areas for system improvement.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498025","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: Improving Health Care Access.","authors":"","doi":"10.7812/TPP/25.098","DOIUrl":"10.7812/TPP/25.098","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333925","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}