The Permanente journal最新文献

{"title":"The Impact of Payment Reform on Medicaid Access and Quality: A National Survey of Physicians.","authors":"Jubi Yl Lin, Joseph H Joo, Lingmei Zhou, Rachna Goswami, Joshua M Liao","doi":"10.7812/TPP/24.121","DOIUrl":"https://doi.org/10.7812/TPP/24.121","url":null,"abstract":"<p><strong>Introduction: </strong>Addressing health inequity should involve improving access and quality of care for individuals with low income. In the United States, programs that involve accountable care incentives and broader risk adjustment are poised to help address these issues. However, there is limited understanding of perspectives among physicians as key stakeholders in determining access and quality.</p><p><strong>Methods: </strong>The authors surveyed physicians about how they perceived accountable care incentives and broader risk adjustment (greater inclusion of clinical, social, and behavioral risk factors) would impact access and quality for patients with low income insured through Medicaid.</p><p><strong>Results: </strong>Low Medicaid reimbursement rates and inadequate adjustment for patients' clinical, social, and behavioral risk factors were major factors why physicians reported not seeing Medicaid patients in their clinical practices. Many physicians believed that accountable care incentives and changes in risk adjustment would help facilitate higher quality of care for Medicaid patients, while the minority of physicians believed that accountable care organizations could ultimately improve the value of care beyond managed care organizations.</p><p><strong>Discussion: </strong>Policymakers could incorporate behavioral, social, and equity-related factors into risk adjustment and consider ways to incorporate accountable care incentives into existing and new entities in Medicaid.</p><p><strong>Conclusion: </strong>The majority of physicians believed that the care of Medicaid patients would improve under accountable care incentives and broader risk adjustment. Understanding physician perspectives is important for contextualizing policy about how payment reforms could affect access and quality of care for Medicaid patients.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796188","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":"Opportunities for Gender-Affirming Care Exposure Across Otolaryngology Programs.","authors":"Seth E Amos, Nathaniel S Neptune, Mitesh P Mehta, David W Chou","doi":"10.7812/TPP/24.197","DOIUrl":"https://doi.org/10.7812/TPP/24.197","url":null,"abstract":"<p><strong>Introduction: </strong>Opportunities for otolaryngology residents to gain exposure and training in gender-affirming care (GAC) are not well-described. The authors examined the prevalence of US otolaryngology residency programs with GAC clinics, surgeons performing gender-affirming surgery (GAS), and faculty that published GAC research.</p><p><strong>Methods: </strong>US otolaryngology residencies were identified with the AMA FREIDA, the AMA Residency & Fellowship Database®. Public program websites were used to identify facial plastic surgeons, laryngologists, and GAC clinics. Faculty were queried in PubMed for publications specific to GAC. Data were collected in January 2024.</p><p><strong>Results: </strong>A total of 92 (70.0%) out of 131 programs had an institutional GAC clinic. Presence of GAC clinics varied between regions, and 42 (32.1%) programs encompassing 765 (41%) residents had ≥ 1 otolaryngology-trained specialist offering GAS. Within each region, programs with any faculty performing GAS were most prevalent in the midwest, with 47% of residencies (16/34 programs) publicly advertising ≥ 1 otolaryngology department faculty member working in the affiliated institutional gender clinic. The next highest region was the west (42%, 9/21 programs), followed by the northeast (29%, 10/34 programs), and lastly the south, with only 17% (7/42 programs) (<i>P</i> = .03). Nationally, 29.0% of programs (36/126), encompassing 652 residents (35.0% of all US trainees) had ≥ 1 otolaryngology faculty member with ≥ 1 GAC publication.</p><p><strong>Discussion: </strong>Most otolaryngology residents in the United States train at institutions with a GAC clinic, but involvement of otolaryngology faculty is highly variable. A minority of residents have any department faculty who perform GAS or research in GAC.</p><p><strong>Conclusion: </strong>Opportunities exist to improve otolaryngology resident exposure to both clinical and scholarly GAC, particularly in the southern region of the United States.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789224","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":"Prognosis of Audiologic Recovery From Sudden Sensorineural Hearing Loss Following Corticosteroid Intervention: A Retrospective Chart Review Across Multiple Outcome Measures.","authors":"Pauline P Huynh, Elias S Saba, Jacob E Hoerter, Nancy Jiang","doi":"10.7812/TPP/24.127","DOIUrl":"https://doi.org/10.7812/TPP/24.127","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate associations among pretreatment hearing deficit, corticosteroid intervention, and audiologic recovery among patients presenting with sudden sensorineural hearing loss within an integrated health system.</p><p><strong>Methods: </strong>Electronic health records within a multicenter integrated health system were queried for clinical encounters with a diagnosis of sudden sensorineural hearing loss in 2021. Patient demographics, audiometric data, and therapeutic steroid intervention were recorded. Audiologic response was defined as a decrease of 15 dB in 4-frequency (500, 1000, 2000, 4000 Hz) pure tone average (PTA). Audiologic recovery, or complete response, was defined as a follow-up PTA (PTA2) of ≤ 25 dB or within 10 dB of 1) baseline or 2) contralateral ear. Logistic regressions were performed to evaluate for predictive factors.</p><p><strong>Results: </strong>A total of 403 patients (mean age 59.27 ± 15.80 years, 57.32% male) met inclusion criteria, of which 355 underwent corticosteroid intervention. The nonsteroid group had a less severe hearing deficit (median PTA1 49.38 dB vs 58.75 dB with steroid group; <i>P</i> < .05). Median PTA improvement was 6.25 dB with steroid therapy and 3.63 dB without (<i>P</i> < .05), but median PTA2 between steroid and nonsteroid users was not significantly different (42.5 dB and 38.13 dB, respectively; <i>P</i> = .821). Steroid intervention within 14 days was predictive of an audiologic response (odds ratio [OR] = 2.33) and recovery (OR = 2.46; both <i>P</i> < .05) compared with patients who did not undergo steroid therapy, whereas delayed steroid intervention was not, regardless of steroid regimen. Severe hearing loss had worse odds of audiologic response (OR = 0.40) or recovery (OR = 0.10; both <i>P</i> < .05) compared with mild hearing loss.</p><p><strong>Conclusion: </strong>Pretreatment hearing deficit and initiation of empiric steroid therapy within 14 days were associated with audiologic prognosis, independent of the corticosteroid regimen. These findings reinforce the benefit of prompt steroid intervention, while further highlighting a need for standardized measures of audiometric outcomes.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721551","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":"Impact of Early vs Delayed Anterior Cruciate Ligament Reconstruction on Tibiofemoral Laxity.","authors":"Virginia Xie, Jacob Ghahremani, Tanya Watarastaporn, Michael Chapek, McKenzie Culler, Andrew Zogby, Daniel Hagaman, Aditya Manoharan, Andrew Fithian, Najeeb Khan","doi":"10.7812/TPP/24.113","DOIUrl":"https://doi.org/10.7812/TPP/24.113","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains controversial. This study evaluated the impact of timing of ACLR on rates of revision, return to the operating room, and pre- and postoperative tibiofemoral laxity.</p><p><strong>Methods: </strong>A retrospective review was performed from January 1, 2010, to December 31, 2015, and included patients ≥ 16 years of age with no history of prior ipsilateral or contralateral knee surgery who underwent primary arthroscopic ACLR. Patients were categorized as early ACLR (< 6 months postinjury) or delayed ACLR (≥ 6 months). Pre- and postoperative manual-maximum differences (MMDs) based on KT-1000 testing and postoperative pivot shift were examined.</p><p><strong>Results: </strong>A total of 611 patients met inclusion criteria (n = 198 early ACLR and n = 413 delayed ACLR). Compared to the early ACLR group, patients receiving delayed ACLR had a lower preoperative MMD (mean 6.55 vs 7.27 mm). Postoperative MMD, as measured by a single physical therapist, was not significantly different for early vs delayed reconstruction. Logistic regression controlling for age, graft type, and postoperative laxity revealed that delayed ACLR was associated with lower odds of return to the operating room (odds ratio = 0.523, <i>P</i> = .045).</p><p><strong>Conclusion: </strong>Delayed ACLR was associated with a lower return to the operating room and no difference in postoperative MMD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701651","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":"The Evolution of the Kaiser Permanente Southern California Regional Virtual Medical Center.","authors":"Khang A Nguyen, Nicolaas Versteeg, Eleanor Morales, Rebecca Hilton","doi":"10.7812/TPP/25.005","DOIUrl":"10.7812/TPP/25.005","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664363","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":"Editor-in-Chief's Response to \"The Evolution of the Kaiser Permanente Southern California Regional Virtual Medical Center\".","authors":"G Richard Holt","doi":"10.7812/TPP/25.023","DOIUrl":"https://doi.org/10.7812/TPP/25.023","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664361","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":"Assessing BE FASTER, a Community of Practice Among Ryan White Part A Clinics in Houston, to Increase Rapid Initiation of Antiretroviral Therapy: A Qualitative, Longitudinal Study.","authors":"Meheret Adera, Bich N Dang, Caleb Brown, Naomi Sequeira, Melanie Goebel, Monisha Arya, Avishek Ghosh-Hajra, Kathryn Fergus, Shital Patel","doi":"10.7812/TPP/24.128","DOIUrl":"10.7812/TPP/24.128","url":null,"abstract":"<p><strong>Background: </strong>Rapid initiation of antiretroviral therapy (Rapid ART) is a key strategy for the <i>Ending the HIV Epidemic</i> inititative. In Harris County, Texas, a priority <i>Ending the HIV Epidemic</i> jurisdiction, 57% of persons with HIV receive care at 1 of 5 public agencies that receive funding from the Ryan White HIV/AIDS Program. The Ryan White HIV/AIDS Program is administered by the US Department of Health and Human Services, Health Resources and Services Administration, and HIV/AIDS Bureau. This program administers grants to clinics and local/state programs to deliver medical and support services (Part A) for low-income persons with HIV. In 2019, 39% of recently diagnosed persons with HIV in Houston took > 1 month to start ART. Herein, the authors evaluate the acceptability of the Baylor College of Medicine ECHO Facilitating Antiretroviral StART Earlier (BE FASTER) program, a community of practice collaborative among 5 Ryan White Part A Clinics, to increase Rapid ART in Harris County, Texas.</p><p><strong>Methods: </strong>Semistructured interviews across 4 time points were conducted among health care workers participating in the BE FASTER program. Interviews took place from November 2021 through February 2023 and were analyzed using rapid qualitative analysis.</p><p><strong>Results: </strong>A total of 29 participants were interviewed. Analyses revealed 6 themes: 1) Rapid ART protocols varied between clinics; 2) participants were interested in getting to know Rapid ART staff at other Ryan White clinics; 3) participants enjoyed the active components of BE FASTER and asked for more opportunities to engage; 4) at the end of BE FASTER, participants reported that they had streamlined their processes for Rapid ART, but barriers to long-term retention remained an ongoing challenge; 5) participants reported an increased sense of community from participating in the BE FASTER program; and 6) overall, participants had a positive experience with BE FASTER.</p><p><strong>Conclusions: </strong>Participants found BE FASTER valuable and reported a positive impact on their cross-agency interactions. The BE FASTER program using the ECHO model can augment the creation of cross-organizational networks for Rapid ART.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658693","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":"Implementing Screening and Treatment Pathways for Teens Who Vape in a Community-Based Pediatrics Clinic in Northern California.","authors":"Daisy Albarran Garcia, Brooke Harris, Alex Tsang, Thomas Tsang, Karen Cerrato, Chynna I Bantug, Wynnyee Tom","doi":"10.7812/TPP/24.087","DOIUrl":"10.7812/TPP/24.087","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this report was to summarize implementation of universal screening and treatment pathways for youth vaping in a large, community-based health care system in the United States.</p><p><strong>Methods: </strong>Data were obtained as a part of routine clinical care and were extracted from medical records weekly for 4 years. Variables reported include number of teens screened, teens who tested positive, referrals, and quit rates, as well as gender and race or ethnicity.</p><p><strong>Results: </strong>Of the 16,671 visits, 12,165 (73%) teens were screened, 632 (5.2%) teens screened positive, and of those who screened positive, 128 (20%) referrals were placed. For those who were referred, 40 teens (31.3%) quit vaping (abstinence for at least 3 weeks) and 21 (16%) decided to receive nicotine replacement therapy (nicotine patches, gum, or lozenges).</p><p><strong>Conclusions: </strong>This study outlines a screening and intervening pathway that can be used in other health care systems in the United States and beyond. Teen vaping can be addressed before it becomes a serious addiction. Institutions can experience cost-saving benefits in that increasing outreach efforts and education would ultimately reduce the number of inpatient/emergency department visits/hospitalizations related to vaping.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"23-26"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Advent of Collagenase <i>Clostridium histolyticum</i> on the Surgical Management of Peyronie's Disease: A Population-Based Analysis.","authors":"Kavenpreet Singh Bal, Priyanka Achalu, Michael O Okene, Aaron Krug, Tung-Chin Hsieh, Hossein Mirheydar","doi":"10.7812/TPP/24.135","DOIUrl":"10.7812/TPP/24.135","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) is a progressive fibrotic disorder of the penis that can induce pain and erectile dysfunction and has various treatment modalities, including surgical, pharmaceutical, and <i>Clostridium histolyticum</i> injection therapies.</p><p><strong>Methods: </strong>The authors used electronic medical records from Kaiser Permanente Southern California, an integrated health care system that consists of 15 medical centers, and identified patients diagnosed with stable PD without concomitant erectile dysfunction from January 1, 2004, to December 31, 2020. Baseline characteristics between surgical and injection groups were compared using Chi-squared and Kruskal-Wallis tests. Multivariable logistic regression with adjustment of confounders was implemented to identify which variables may influence whether patients received injection or surgical therapy.</p><p><strong>Results: </strong>A total of 11,706 patients with PD were identified. The rate of new PD diagnosis per 100,000 patients increased by 0.37 every year, <i>P</i> < .05. The incident rate (per 1000 eligible patients) of surgical management declined on average by 0.40 each year (<i>P</i> < .001), although there was an increase rate of 1.19 for injection therapy (<i>P</i> < .001). On multivariable modeling, patients 45-54 years of age were more likely to receive injection therapy as the primary treatment for PD (adjusted odds ratio = 2.77; <i>P</i> = .002; confidence interval = 1.34-5.73).</p><p><strong>Conclusion: </strong>This study illustrates that pentoxifylline is now more frequently used than colchicine and vitamin E as oral treatments for PD, while collagenase <i>C. histolyticum</i> injection therapy is now more prevalently employed than surgical intervention as the therapeutic approach for PD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the Food and Drug Administration Pipeline and Proposed California Legislation on Medicinal Psychedelics.","authors":"Jack R Watson, Laura Halpin, Violeta Barroso, George Dahdouh, Jacqueline Bursalyan, Saahil Mohta, Michelle Flores, Natalie Gonzalez, John Gordineer, Germain Medina, Crystal Oseguera, Jailene Lazaro Serrano","doi":"10.7812/TPP/24.171","DOIUrl":"10.7812/TPP/24.171","url":null,"abstract":"<p><p>Psychedelic and empathogenic compounds show promise for a variety of conditions. However, studying these compounds can be highly complex, be very expensive, and have substantial patient safety concerns. Here, the authors will review 8 late-phase medicinal psychedelic studies in the Food and Drug Adminisration (FDA) approval pipeline. The authors will include a review of the FDA's recent denial of the New Drug Application for 3-4-methylenedioxymethamphetamine with adjuvant psychotherapy for posttraumatic stress disorder from Lykos Therapeutics of San Jose, California (formerly the Multidisciplinary Association for Psychedelic Studies Public Benefit Corporation). Additionally, the authors will discuss the parallel legislative proposals in California to legalize psychedelic compounds for adult use. These legislative efforts reflect an alternative and less expensive pathway, but they do not make as thorough of an evaluation for drug safety. The authors will propose that the FDA remains the appropriate agency to evaluate and approve the use of this class of proposed therapeutics.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"89-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}