D plans in California were included if they had diabetes; signed up for Part D between November 1... more D plans in California were included if they had diabetes; signed up for Part D between November 15, 2005 and March 1, 2006; and had a drug coverage gap starting at $2,250. Entry and exit into the gap was determined using pharmacy databases. Beneficiaries hit the gap after incurring $2,250 in total drug costs; beneficiaries exited the gap after incurring $3,600 in out-ofpocket costs. Results: In 2006, 25% of the 45,732 beneficiaries reached the coverage gap and then paid the full price of their drugs. Only 1% of beneficiaries exited the gap and qualified for 'catastrophic' drug cost assistance. On average, diabetes beneficiaries incurred $1,942 in total drug costs during 2006. For beneficiaries who did not enter the coverage gap, total drug expenditures and out-of-pocket drug expenditures remained stable over the year. For the beneficiaries who fell into the drug coverage gap in 2006, total drug costs were much higher overall and decreased over the year as outof-pocket expenses increased. Conclusions: This is the first examination of diabetic Medicare beneficiaries under the Part D program. Fewer entered the coverage gap than had been previously estimated. Those entering the gap, however, had lower subsequent monthly drug expenditures. Potential reasons for both include lower than expected drug prices or drug adherence and higher than expected use of less expensive drugs, such as generics. Future work will examine these alternative explanations and explore risk factors for entering the Part D coverage gap.
Recently, substantial undisclosed financial Conflicts of Interest (COI) by researchers at academi... more Recently, substantial undisclosed financial Conflicts of Interest (COI) by researchers at academic medical centers have been discovered and reported in US Senate investigations, prompting large research institutions to take a close look at policies and procedures associated with the reporting and with the management of researcher COI. This article defines COI, reviews the background, describes the problems that arise, and offers solutions.
In Part One, the authors addressed the relevance of genetic information, and how race and genetic... more In Part One, the authors addressed the relevance of genetic information, and how race and genetics have affected and may impact the development of medicines, pharmacogenomics, and personalized medicine in the United States. Part Two examines current and proposed federal and state laws and regulations intended to protect individuals from the misuse of genetic information, including uses that discriminate based on genetic predispositions. This Part next explores the potential for litigation against both manufacturers and providers,as well as potential defenses. The authors also discuss legal issues relating to research that relies on the use of genetic information.
One of the more controversial elements of advancing technology is the use of race and genetics to... more One of the more controversial elements of advancing technology is the use of race and genetics to help create more specific types of medicines that will help combat diseases and conditions that appear to be more prevalent within certain races or ethnic groups than in others. Considering the history of discrimination and inadequate treatment of individuals on the bases of race and gender in the United States, there is justifiable concern that race or gender-based treatment could be used to legitimate discrimination. On the other hand, there is substantial proof that the current method of creating medicines for the general public is problematic and could prevent effective treatments from reaching the marketplace. Part One of this series addresses the relevance of genetic information, and how race and genetics have affected and may impact the development of medicines, pharmacogenomics, and personalized medicine in the United States. Part Two, which will appear in the next issue of the ...
Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Di... more Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Disorder (ASD). Unfortunately, there is no identified etiology or definitive cure for ASD. Therefore, it is not surprising that many parents turn to complementary and alternative medicine (CAM) therapies for their affected children. Prior studies have suggested that CAM use is common in this population; however, these studies have been limited by small samples and an inability to assess response rates. The purpose of this analysis is to examine the prevalence and correlates of CAM use among a group of geographically-and racially/ethnically-diverse children with ASD who are enrolled in the Mental Health Research Network (MHRN) Autism Registry. Methods: A web-based survey of parents of children with ASD was implemented at 4 MHRN Autism Registry sites in order to obtain information not available in health plan databases including parents' use of CAM. Parents were asked to report what CAM therapies they have ever used/used within the past 3 months, what they have paid for these therapies and the degree to which they perceived them as harmful or helpful. The domains of CAM therapies on the survey included natural products (e.g., vitamins), mind-body medicine (e.g., acupuncture) and manipulative/body-based practices (e.g., chiropractic). Results: To date, approximately 8800 recruitment letters have been mailed and 800 surveys have been completed. Findings related to the prevalence of CAM use among this population, in addition to the correlates of CAM use (including socio-demographics, age at diagnosis, severity of ASD, medical co-morbidities, health care utilization and parental satisfaction with care) will be presented. Conclusions: We were able to successfully implement a web-based survey of parents of children with ASD across 4 MHRN sites. With 800 completed surveys (recruitment will continue through November 2012 and thus this number is expected to increase), this is the largest known population-based survey on CAM use in a population with ASD to date. Prior studies indicate that CAM use among this population is common; therefore, it is critical that providers understand this phenomenon so they can help families make well-informed health care decisions and prevent possible CAM-drug interactions.
Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Di... more Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Disorder (ASD). Unfortunately, there is no identified etiology or definitive cure for ASD. Therefore, it is not surprising that many parents turn to complementary and alternative medicine (CAM) therapies for their affected children. Prior studies have suggested that CAM use is common in this population; however, these studies have been limited by small samples and an inability to assess response rates. The purpose of this analysis is to examine the prevalence and correlates of CAM use among a group of geographically-and racially/ethnically-diverse children with ASD who are enrolled in the Mental Health Research Network (MHRN) Autism Registry. Methods: A web-based survey of parents of children with ASD was implemented at 4 MHRN Autism Registry sites in order to obtain information not available in health plan databases including parents' use of CAM. Parents were asked to report what CAM therapies they have ever used/used within the past 3 months, what they have paid for these therapies and the degree to which they perceived them as harmful or helpful. The domains of CAM therapies on the survey included natural products (e.g., vitamins), mind-body medicine (e.g., acupuncture) and manipulative/body-based practices (e.g., chiropractic). Results: To date, approximately 8800 recruitment letters have been mailed and 800 surveys have been completed. Findings related to the prevalence of CAM use among this population, in addition to the correlates of CAM use (including socio-demographics, age at diagnosis, severity of ASD, medical co-morbidities, health care utilization and parental satisfaction with care) will be presented. Conclusions: We were able to successfully implement a web-based survey of parents of children with ASD across 4 MHRN sites. With 800 completed surveys (recruitment will continue through November 2012 and thus this number is expected to increase), this is the largest known population-based survey on CAM use in a population with ASD to date. Prior studies indicate that CAM use among this population is common; therefore, it is critical that providers understand this phenomenon so they can help families make well-informed health care decisions and prevent possible CAM-drug interactions.
D plans in California were included if they had diabetes; signed up for Part D between November 1... more D plans in California were included if they had diabetes; signed up for Part D between November 15, 2005 and March 1, 2006; and had a drug coverage gap starting at $2,250. Entry and exit into the gap was determined using pharmacy databases. Beneficiaries hit the gap after incurring $2,250 in total drug costs; beneficiaries exited the gap after incurring $3,600 in out-ofpocket costs. Results: In 2006, 25% of the 45,732 beneficiaries reached the coverage gap and then paid the full price of their drugs. Only 1% of beneficiaries exited the gap and qualified for 'catastrophic' drug cost assistance. On average, diabetes beneficiaries incurred $1,942 in total drug costs during 2006. For beneficiaries who did not enter the coverage gap, total drug expenditures and out-of-pocket drug expenditures remained stable over the year. For the beneficiaries who fell into the drug coverage gap in 2006, total drug costs were much higher overall and decreased over the year as outof-pocket expenses increased. Conclusions: This is the first examination of diabetic Medicare beneficiaries under the Part D program. Fewer entered the coverage gap than had been previously estimated. Those entering the gap, however, had lower subsequent monthly drug expenditures. Potential reasons for both include lower than expected drug prices or drug adherence and higher than expected use of less expensive drugs, such as generics. Future work will examine these alternative explanations and explore risk factors for entering the Part D coverage gap.
incidence is unclear. Improved understanding of this association may hold significant potential f... more incidence is unclear. Improved understanding of this association may hold significant potential for population health improvement strategies. The purpose of this investigation was to study the association of adherence to varying levels of an optimal lifestyle with the incidence of chronic disease among employed adults (N=35,684). Methods: All baseline data were collected as part of a health assessment process during the year 2007. Participants were followed for two years. Descriptive statistics were calculated and reported as the proportion of the sample reporting a newly diagnosed chronic disease (diabetes, heart disease, hyperlipidemia, hypertension, back pain, or cancer) by the number of lifestyle behaviors that they practiced. Results: Compared with individuals who practiced no or only 1 optimal lifestyle behavior, the risk of developing a condition for individuals practicing 3 or 4 behaviors was 66% lower for diabetes, 45% lower for heart disease, 17% lower for hyperlipidemia, 15% lower for hypertension, 43% lower for back pain, and 24% lower for cancer. Conclusions: Adherence to optimal lifestyle is associated with lower 2-year incidence rates of several chronic conditions. Attention to population-based strategies that improve adherence to these four behaviors appears to positively affect risk of chronic diseases and their risk factors. To the extent that social marketing strategies and systematic measurement and feedback to individual members, patients, and groups (e.g., employer-based) increases adherence to multiple health behaviors, risk of chronic disease may be reduced.
Background/Aims: Within the HMORN multi-site collaborations are routine but as they grow in size ... more Background/Aims: Within the HMORN multi-site collaborations are routine but as they grow in size and scope, the common challenges of managing these projects becomes more complex. As funders look to the HMORN as a model for distributed research, it is important to document best practices across projects and institutions. Methods: Using examples from across the HMORN, we will explore best practices and common challenges for successfully implementing large scale projects. Topics will include: • strategies for large scale communication • working with external partners • privacy and human subjects • contracting and budgeting • general management of large scale network projects. Each topic will feature examples of common issues across HMORN programs and highlight a lesson learned from the Cancer Research Network, Mini-Sentinel and other large collaborations. Effective innovations or approaches, as well as barriers and challenges will be highlighted. Discussion: As one of the most successful health care research networks, the experience and expertise of the HMORN can provide strategies and guidance to enhance and expand new and ongoing collaborations.
Background: With mounting economic burdens of diabetes and its complications, its implications on... more Background: With mounting economic burdens of diabetes and its complications, its implications on dental cost are not well studied. Diabetes has been established as an important risk factor for periodontal disease and subsequent tooth loss, but surprisingly few longitudinal studies have examined the relationship between diabetes and dental care costs. ObjectiveTo evaluate associations between diabetes and costs of dental care from a 5-year prospective observation of the insured with and without diagnosed diabetes. Methods/Research Design: This was a cohort analysis using linked data from Washington Dental Service and Group Health Cooperative on enrollees continuously and dually insured from 2002-2006. Adults with and without diabetes were matched on baseline characteristics using propensity scores and then compared on 5 years of follow-up dental costs. Results: Of the 49,023 linked enrollees that met the study inclusion criteria, 4,038 (8.24%) enrollees met criteria for diabetes. Post matching results show that adults with diabetes had 3% lower attendance to a dentist compared to the matched controls (P < 0.001). Among those with a dental visit, diabetes patients were costlier than the control group in non-surgical periodontal procedures, extractions and removable prosthetics (P < 0.001 for all) and were less expensive in diagnostic, preventive and restorative (fillings and crowns) procedures (P < 0.001 for all). There was no significant difference in total dental care cost between the two groups. Conclusions: Despite the lack of difference in total cost for dental care, the distribution of costs across procedure-classes was significantly different for patients with diabetes with higher emphasis on tooth replacing procedures than tooth-retaining procedures. In an administrative services-only arrangement with indemnity and PPO plans, the improved utilization of preventive dental care could accrue cost savings to patients and employers through reduction in downstream costs related to intensive procedures and in indirect costs related to lost productivity and time.
Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorder... more Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorders (WRMSDs), but a lack of standardized measurement tools reflects both the theoretical and methodological limitations of current research. An interdisciplinary team including biomedical, behavioral, and social science researchers used an iterative process to adapt existing instruments for an interviewer-administered questionnaire assessing psychosocial workplace exposure related to musculoskeletal disorders. The resulting questionnaire included measures of psychosocial workplace factors based on two theoretical models (the demand-control-support and the effort-reward imbalance models), supplemented by the additional constructs of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;emotional demands,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;experiences of discrimination.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Other psychosocial and physical measures selected for questionnaire inclusion address physical workload, sociodemographic and anthropometric characteristics, social relations and life events, health behaviors, and physical and psychological health. Using an interdisciplinary approach facilitated the development of a comprehensive questionnaire inclusive of key measures of psychosocial factors that may play a role in the complex mechanisms leading to WRMSDs.
HMORN 2012-Selected Abstracts mainly Asian/Pacific Islanders (APIs). Disparity by race exists for... more HMORN 2012-Selected Abstracts mainly Asian/Pacific Islanders (APIs). Disparity by race exists for APIs which makeup approximately 4% of the U.S. population and more than 2% of these races are affected with chronic HBV. The purpose of this study is to investigate the demographic differences between the foreign-born and US-born HBV infected APIs of Kaiser Permanente, Hawai'i (KPHI). Methods: This substudy is a part of a prospective, dynamic, longitudinal and observational study, the Chronic Hepatitis Cohort Study (CHeCS). Patients included in this analysis were APIs identified from electronic medical records who met the CHeCS definition for chronic HBV infection at KPHI. Date of birth, race, gender, and country of origin (COO), household income and education were obtained from the Virtual Data Warehouse (VDW) demographic and census tables. Information about the country of origin was also supplemented by surveys and chart abstractions. Results: Of the 513 HBV infected APIs, 76% were foreign-born and 24 % were US-born. HBV infected foreign-born APIs were significantly younger than the US-born APIs; approximately 50% of HBV infected foreign-born APIs were in 40-59 years old age group compared to 32% of the US-born. Foreign-born APIs also had significantly higher proportion of females (55%) than US-born (50%). Most of the HBV infected APIs had a median household income between 50,000 and 75,000 with no significant differences between the groups. Approximate prevalence was also calculated using the KPHI utilization data. APIs had an overall HBV prevalence of 0.7%; foreign-born APIs had 2.6% and US-born APIs had 0.3% prevalence. Discussion: In summary, foreign-born APIs have higher prevalence of chronic HBV infections compared to US-born APIs in Kaiser Permanente Hawai'i. Foreign-born APIs infected with HBV are younger and more likely to be females than US-born APIs.
D plans in California were included if they had diabetes; signed up for Part D between November 1... more D plans in California were included if they had diabetes; signed up for Part D between November 15, 2005 and March 1, 2006; and had a drug coverage gap starting at $2,250. Entry and exit into the gap was determined using pharmacy databases. Beneficiaries hit the gap after incurring $2,250 in total drug costs; beneficiaries exited the gap after incurring $3,600 in out-ofpocket costs. Results: In 2006, 25% of the 45,732 beneficiaries reached the coverage gap and then paid the full price of their drugs. Only 1% of beneficiaries exited the gap and qualified for 'catastrophic' drug cost assistance. On average, diabetes beneficiaries incurred $1,942 in total drug costs during 2006. For beneficiaries who did not enter the coverage gap, total drug expenditures and out-of-pocket drug expenditures remained stable over the year. For the beneficiaries who fell into the drug coverage gap in 2006, total drug costs were much higher overall and decreased over the year as outof-pocket expenses increased. Conclusions: This is the first examination of diabetic Medicare beneficiaries under the Part D program. Fewer entered the coverage gap than had been previously estimated. Those entering the gap, however, had lower subsequent monthly drug expenditures. Potential reasons for both include lower than expected drug prices or drug adherence and higher than expected use of less expensive drugs, such as generics. Future work will examine these alternative explanations and explore risk factors for entering the Part D coverage gap.
Recently, substantial undisclosed financial Conflicts of Interest (COI) by researchers at academi... more Recently, substantial undisclosed financial Conflicts of Interest (COI) by researchers at academic medical centers have been discovered and reported in US Senate investigations, prompting large research institutions to take a close look at policies and procedures associated with the reporting and with the management of researcher COI. This article defines COI, reviews the background, describes the problems that arise, and offers solutions.
In Part One, the authors addressed the relevance of genetic information, and how race and genetic... more In Part One, the authors addressed the relevance of genetic information, and how race and genetics have affected and may impact the development of medicines, pharmacogenomics, and personalized medicine in the United States. Part Two examines current and proposed federal and state laws and regulations intended to protect individuals from the misuse of genetic information, including uses that discriminate based on genetic predispositions. This Part next explores the potential for litigation against both manufacturers and providers,as well as potential defenses. The authors also discuss legal issues relating to research that relies on the use of genetic information.
One of the more controversial elements of advancing technology is the use of race and genetics to... more One of the more controversial elements of advancing technology is the use of race and genetics to help create more specific types of medicines that will help combat diseases and conditions that appear to be more prevalent within certain races or ethnic groups than in others. Considering the history of discrimination and inadequate treatment of individuals on the bases of race and gender in the United States, there is justifiable concern that race or gender-based treatment could be used to legitimate discrimination. On the other hand, there is substantial proof that the current method of creating medicines for the general public is problematic and could prevent effective treatments from reaching the marketplace. Part One of this series addresses the relevance of genetic information, and how race and genetics have affected and may impact the development of medicines, pharmacogenomics, and personalized medicine in the United States. Part Two, which will appear in the next issue of the ...
Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Di... more Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Disorder (ASD). Unfortunately, there is no identified etiology or definitive cure for ASD. Therefore, it is not surprising that many parents turn to complementary and alternative medicine (CAM) therapies for their affected children. Prior studies have suggested that CAM use is common in this population; however, these studies have been limited by small samples and an inability to assess response rates. The purpose of this analysis is to examine the prevalence and correlates of CAM use among a group of geographically-and racially/ethnically-diverse children with ASD who are enrolled in the Mental Health Research Network (MHRN) Autism Registry. Methods: A web-based survey of parents of children with ASD was implemented at 4 MHRN Autism Registry sites in order to obtain information not available in health plan databases including parents' use of CAM. Parents were asked to report what CAM therapies they have ever used/used within the past 3 months, what they have paid for these therapies and the degree to which they perceived them as harmful or helpful. The domains of CAM therapies on the survey included natural products (e.g., vitamins), mind-body medicine (e.g., acupuncture) and manipulative/body-based practices (e.g., chiropractic). Results: To date, approximately 8800 recruitment letters have been mailed and 800 surveys have been completed. Findings related to the prevalence of CAM use among this population, in addition to the correlates of CAM use (including socio-demographics, age at diagnosis, severity of ASD, medical co-morbidities, health care utilization and parental satisfaction with care) will be presented. Conclusions: We were able to successfully implement a web-based survey of parents of children with ASD across 4 MHRN sites. With 800 completed surveys (recruitment will continue through November 2012 and thus this number is expected to increase), this is the largest known population-based survey on CAM use in a population with ASD to date. Prior studies indicate that CAM use among this population is common; therefore, it is critical that providers understand this phenomenon so they can help families make well-informed health care decisions and prevent possible CAM-drug interactions.
Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Di... more Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Disorder (ASD). Unfortunately, there is no identified etiology or definitive cure for ASD. Therefore, it is not surprising that many parents turn to complementary and alternative medicine (CAM) therapies for their affected children. Prior studies have suggested that CAM use is common in this population; however, these studies have been limited by small samples and an inability to assess response rates. The purpose of this analysis is to examine the prevalence and correlates of CAM use among a group of geographically-and racially/ethnically-diverse children with ASD who are enrolled in the Mental Health Research Network (MHRN) Autism Registry. Methods: A web-based survey of parents of children with ASD was implemented at 4 MHRN Autism Registry sites in order to obtain information not available in health plan databases including parents' use of CAM. Parents were asked to report what CAM therapies they have ever used/used within the past 3 months, what they have paid for these therapies and the degree to which they perceived them as harmful or helpful. The domains of CAM therapies on the survey included natural products (e.g., vitamins), mind-body medicine (e.g., acupuncture) and manipulative/body-based practices (e.g., chiropractic). Results: To date, approximately 8800 recruitment letters have been mailed and 800 surveys have been completed. Findings related to the prevalence of CAM use among this population, in addition to the correlates of CAM use (including socio-demographics, age at diagnosis, severity of ASD, medical co-morbidities, health care utilization and parental satisfaction with care) will be presented. Conclusions: We were able to successfully implement a web-based survey of parents of children with ASD across 4 MHRN sites. With 800 completed surveys (recruitment will continue through November 2012 and thus this number is expected to increase), this is the largest known population-based survey on CAM use in a population with ASD to date. Prior studies indicate that CAM use among this population is common; therefore, it is critical that providers understand this phenomenon so they can help families make well-informed health care decisions and prevent possible CAM-drug interactions.
D plans in California were included if they had diabetes; signed up for Part D between November 1... more D plans in California were included if they had diabetes; signed up for Part D between November 15, 2005 and March 1, 2006; and had a drug coverage gap starting at $2,250. Entry and exit into the gap was determined using pharmacy databases. Beneficiaries hit the gap after incurring $2,250 in total drug costs; beneficiaries exited the gap after incurring $3,600 in out-ofpocket costs. Results: In 2006, 25% of the 45,732 beneficiaries reached the coverage gap and then paid the full price of their drugs. Only 1% of beneficiaries exited the gap and qualified for 'catastrophic' drug cost assistance. On average, diabetes beneficiaries incurred $1,942 in total drug costs during 2006. For beneficiaries who did not enter the coverage gap, total drug expenditures and out-of-pocket drug expenditures remained stable over the year. For the beneficiaries who fell into the drug coverage gap in 2006, total drug costs were much higher overall and decreased over the year as outof-pocket expenses increased. Conclusions: This is the first examination of diabetic Medicare beneficiaries under the Part D program. Fewer entered the coverage gap than had been previously estimated. Those entering the gap, however, had lower subsequent monthly drug expenditures. Potential reasons for both include lower than expected drug prices or drug adherence and higher than expected use of less expensive drugs, such as generics. Future work will examine these alternative explanations and explore risk factors for entering the Part D coverage gap.
incidence is unclear. Improved understanding of this association may hold significant potential f... more incidence is unclear. Improved understanding of this association may hold significant potential for population health improvement strategies. The purpose of this investigation was to study the association of adherence to varying levels of an optimal lifestyle with the incidence of chronic disease among employed adults (N=35,684). Methods: All baseline data were collected as part of a health assessment process during the year 2007. Participants were followed for two years. Descriptive statistics were calculated and reported as the proportion of the sample reporting a newly diagnosed chronic disease (diabetes, heart disease, hyperlipidemia, hypertension, back pain, or cancer) by the number of lifestyle behaviors that they practiced. Results: Compared with individuals who practiced no or only 1 optimal lifestyle behavior, the risk of developing a condition for individuals practicing 3 or 4 behaviors was 66% lower for diabetes, 45% lower for heart disease, 17% lower for hyperlipidemia, 15% lower for hypertension, 43% lower for back pain, and 24% lower for cancer. Conclusions: Adherence to optimal lifestyle is associated with lower 2-year incidence rates of several chronic conditions. Attention to population-based strategies that improve adherence to these four behaviors appears to positively affect risk of chronic diseases and their risk factors. To the extent that social marketing strategies and systematic measurement and feedback to individual members, patients, and groups (e.g., employer-based) increases adherence to multiple health behaviors, risk of chronic disease may be reduced.
Background/Aims: Within the HMORN multi-site collaborations are routine but as they grow in size ... more Background/Aims: Within the HMORN multi-site collaborations are routine but as they grow in size and scope, the common challenges of managing these projects becomes more complex. As funders look to the HMORN as a model for distributed research, it is important to document best practices across projects and institutions. Methods: Using examples from across the HMORN, we will explore best practices and common challenges for successfully implementing large scale projects. Topics will include: • strategies for large scale communication • working with external partners • privacy and human subjects • contracting and budgeting • general management of large scale network projects. Each topic will feature examples of common issues across HMORN programs and highlight a lesson learned from the Cancer Research Network, Mini-Sentinel and other large collaborations. Effective innovations or approaches, as well as barriers and challenges will be highlighted. Discussion: As one of the most successful health care research networks, the experience and expertise of the HMORN can provide strategies and guidance to enhance and expand new and ongoing collaborations.
Background: With mounting economic burdens of diabetes and its complications, its implications on... more Background: With mounting economic burdens of diabetes and its complications, its implications on dental cost are not well studied. Diabetes has been established as an important risk factor for periodontal disease and subsequent tooth loss, but surprisingly few longitudinal studies have examined the relationship between diabetes and dental care costs. ObjectiveTo evaluate associations between diabetes and costs of dental care from a 5-year prospective observation of the insured with and without diagnosed diabetes. Methods/Research Design: This was a cohort analysis using linked data from Washington Dental Service and Group Health Cooperative on enrollees continuously and dually insured from 2002-2006. Adults with and without diabetes were matched on baseline characteristics using propensity scores and then compared on 5 years of follow-up dental costs. Results: Of the 49,023 linked enrollees that met the study inclusion criteria, 4,038 (8.24%) enrollees met criteria for diabetes. Post matching results show that adults with diabetes had 3% lower attendance to a dentist compared to the matched controls (P < 0.001). Among those with a dental visit, diabetes patients were costlier than the control group in non-surgical periodontal procedures, extractions and removable prosthetics (P < 0.001 for all) and were less expensive in diagnostic, preventive and restorative (fillings and crowns) procedures (P < 0.001 for all). There was no significant difference in total dental care cost between the two groups. Conclusions: Despite the lack of difference in total cost for dental care, the distribution of costs across procedure-classes was significantly different for patients with diabetes with higher emphasis on tooth replacing procedures than tooth-retaining procedures. In an administrative services-only arrangement with indemnity and PPO plans, the improved utilization of preventive dental care could accrue cost savings to patients and employers through reduction in downstream costs related to intensive procedures and in indirect costs related to lost productivity and time.
Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorder... more Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorders (WRMSDs), but a lack of standardized measurement tools reflects both the theoretical and methodological limitations of current research. An interdisciplinary team including biomedical, behavioral, and social science researchers used an iterative process to adapt existing instruments for an interviewer-administered questionnaire assessing psychosocial workplace exposure related to musculoskeletal disorders. The resulting questionnaire included measures of psychosocial workplace factors based on two theoretical models (the demand-control-support and the effort-reward imbalance models), supplemented by the additional constructs of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;emotional demands,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;experiences of discrimination.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Other psychosocial and physical measures selected for questionnaire inclusion address physical workload, sociodemographic and anthropometric characteristics, social relations and life events, health behaviors, and physical and psychological health. Using an interdisciplinary approach facilitated the development of a comprehensive questionnaire inclusive of key measures of psychosocial factors that may play a role in the complex mechanisms leading to WRMSDs.
HMORN 2012-Selected Abstracts mainly Asian/Pacific Islanders (APIs). Disparity by race exists for... more HMORN 2012-Selected Abstracts mainly Asian/Pacific Islanders (APIs). Disparity by race exists for APIs which makeup approximately 4% of the U.S. population and more than 2% of these races are affected with chronic HBV. The purpose of this study is to investigate the demographic differences between the foreign-born and US-born HBV infected APIs of Kaiser Permanente, Hawai'i (KPHI). Methods: This substudy is a part of a prospective, dynamic, longitudinal and observational study, the Chronic Hepatitis Cohort Study (CHeCS). Patients included in this analysis were APIs identified from electronic medical records who met the CHeCS definition for chronic HBV infection at KPHI. Date of birth, race, gender, and country of origin (COO), household income and education were obtained from the Virtual Data Warehouse (VDW) demographic and census tables. Information about the country of origin was also supplemented by surveys and chart abstractions. Results: Of the 513 HBV infected APIs, 76% were foreign-born and 24 % were US-born. HBV infected foreign-born APIs were significantly younger than the US-born APIs; approximately 50% of HBV infected foreign-born APIs were in 40-59 years old age group compared to 32% of the US-born. Foreign-born APIs also had significantly higher proportion of females (55%) than US-born (50%). Most of the HBV infected APIs had a median household income between 50,000 and 75,000 with no significant differences between the groups. Approximate prevalence was also calculated using the KPHI utilization data. APIs had an overall HBV prevalence of 0.7%; foreign-born APIs had 2.6% and US-born APIs had 0.3% prevalence. Discussion: In summary, foreign-born APIs have higher prevalence of chronic HBV infections compared to US-born APIs in Kaiser Permanente Hawai'i. Foreign-born APIs infected with HBV are younger and more likely to be females than US-born APIs.
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Papers by Jeffrey Braff