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  1. Article ; Online: External Validation of the eRADAR Risk Score for Detecting Undiagnosed Dementia in Two Real-World Healthcare Systems.

    Coley, R Yates / Smith, Julia J / Karliner, Leah / Idu, Abisola E / Lee, Sei J / Fuller, Sharon / Lam, Rosemary / Barnes, Deborah E / Dublin, Sascha

    Journal of general internal medicine

    2022  Volume 38, Issue 2, Page(s) 351–360

    Abstract: Background: Fifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using ... ...

    Abstract Background: Fifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using routinely collected clinical data.
    Objective: To externally validate eRADAR in two real-world healthcare systems, including examining performance over time and by race/ethnicity.
    Design: Retrospective cohort study PARTICIPANTS: 129,315 members of Kaiser Permanente Washington (KPWA), an integrated health system providing insurance coverage and medical care, and 13,444 primary care patients at University of California San Francisco Health (UCSF), an academic medical system, aged 65 years or older without prior EHR documentation of dementia diagnosis or medication.
    Main measures: Performance of eRADAR scores, calculated annually from EHR data (including vital signs, diagnoses, medications, and utilization in the prior 2 years), for predicting EHR documentation of incident dementia diagnosis within 12 months.
    Key results: A total of 7631 dementia diagnoses were observed at KPWA (11.1 per 1000 person-years) and 216 at UCSF (4.6 per 1000 person-years). The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90
    Conclusions: eRADAR showed strong external validity for detecting undiagnosed dementia in two health systems with different patient populations and differential availability of external healthcare data for risk calculations. In this study, eRADAR demonstrated generalizability from a research sample to real-world clinical populations, transportability across health systems, robustness to temporal changes in healthcare, and similar performance across larger racial/ethnic groups.
    MeSH term(s) Humans ; Aged ; Retrospective Studies ; Delivery of Health Care ; Risk Factors ; Washington ; Dementia/diagnosis
    Language English
    Publishing date 2022-07-29
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-022-07736-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2205: Show issues Location:
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  2. Article ; Online: Baseline representativeness of patients in clinics enrolled in the PRimary care Opioid Use Disorders treatment (PROUD) trial: comparison of trial and non-trial clinics in the same health systems.

    Wartko, Paige D / Qiu, Hongxiang / Idu, Abisola E / Yu, Onchee / McCormack, Jennifer / Matthews, Abigail G / Bobb, Jennifer F / Saxon, Andrew J / Campbell, Cynthia I / Liu, David / Braciszewski, Jordan M / Murphy, Sean M / Burganowski, Rachael P / Murphy, Mark T / Horigian, Viviana E / Hamilton, Leah K / Lee, Amy K / Boudreau, Denise M / Bradley, Katharine A

    BMC health services research

    2022  Volume 22, Issue 1, Page(s) 1593

    Abstract: Background: Pragmatic primary care trials aim to test interventions in "real world" health care settings, but clinics willing and able to participate in trials may not be representative of typical clinics. This analysis compared patients in ... ...

    Abstract Background: Pragmatic primary care trials aim to test interventions in "real world" health care settings, but clinics willing and able to participate in trials may not be representative of typical clinics. This analysis compared patients in participating and non-participating clinics from the same health systems at baseline in the PRimary care Opioid Use Disorders treatment (PROUD) trial.
    Methods: This observational analysis relied on secondary electronic health record and administrative claims data in 5 of 6 health systems in the PROUD trial. The sample included patients 16-90 years at an eligible primary care visit in the 3 years before randomization. Each system contributed 2 randomized PROUD trial clinics and 4 similarly sized non-trial clinics. We summarized patient characteristics in trial and non-trial clinics in the 2 years before randomization ("baseline"). Using mixed-effect regression models, we compared trial and non-trial clinics on a baseline measure of the primary trial outcome (clinic-level patient-years of opioid use disorder (OUD) treatment, scaled per 10,000 primary care patients seen) and a baseline measure of the secondary trial outcome (patient-level days of acute care utilization among patients with OUD).
    Results: Patients were generally similar between the 10 trial clinics (n = 248,436) and 20 non-trial clinics (n = 341,130), although trial clinics' patients were slightly younger, more likely to be Hispanic/Latinx, less likely to be white, more likely to have Medicaid/subsidized insurance, and lived in less wealthy neighborhoods. Baseline outcomes did not differ between trial and non-trial clinics: trial clinics had 1.0 more patient-year of OUD treatment per 10,000 patients (95% CI: - 2.9, 5.0) and a 4% higher rate of days of acute care utilization than non-trial clinics (rate ratio: 1.04; 95% CI: 0.76, 1.42).
    Conclusions: trial clinics and non-trial clinics were similar regarding most measured patient characteristics, and no differences were observed in baseline measures of trial primary and secondary outcomes. These findings suggest trial clinics were representative of comparably sized clinics within the same health systems. Although results do not reflect generalizability more broadly, this study illustrates an approach to assess representativeness of clinics in future pragmatic primary care trials.
    MeSH term(s) United States ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/complications ; Medicaid ; Insurance ; Electronic Health Records ; Primary Health Care/methods
    Language English
    Publishing date 2022-12-29
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-022-08915-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder.

    Braciszewski, Jordan M / Idu, Abisola E / Yarborough, Bobbi Jo H / Stumbo, Scott P / Bobb, Jennifer F / Bradley, Katharine A / Rossom, Rebecca C / Murphy, Mark T / Binswanger, Ingrid A / Campbell, Cynthia I / Glass, Joseph E / Matson, Theresa E / Lapham, Gwen T / Loree, Amy M / Barbosa-Leiker, Celestina / Hatch, Mary A / Tsui, Judith I / Arnsten, Julia H / Stotts, Angela /
    Horigian, Viviana / Hutcheson, Rebecca / Bart, Gavin / Saxon, Andrew J / Thakral, Manu / Ling Grant, Deborah / Pflugeisen, Chaya Mangel / Usaga, Ingrid / Madziwa, Lawrence T / Silva, Angela / Boudreau, Denise M

    Psychiatric services (Washington, D.C.)

    2022  Volume 73, Issue 12, Page(s) 1330–1337

    Abstract: Objective: The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems.: Methods!# ...

    Abstract Objective: The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems.
    Methods: This retrospective study used 2014-2016 data from patients ages ≥16 years in six health systems. Diagnoses were obtained from electronic health records or claims data; opioid use disorder treatment with buprenorphine or injectable extended-release naltrexone was determined through prescription and procedure data. Adjusted prevalence of comorbid conditions among patients with opioid use disorder (with or without treatment), stratified by sex, was estimated by fitting logistic regression models for each condition and applying marginal standardization.
    Results: Females (53.2%, N=7,431) and males (46.8%, N=6,548) had a similar prevalence of opioid use disorder. Comorbid mental disorders among those with opioid use disorder were more prevalent among females (86.4% vs. 74.3%, respectively), whereas comorbid other substance use disorders (excluding nicotine) were more common among males (51.9% vs. 60.9%, respectively). These differences held for those receiving medication treatment for opioid use disorder, with mental disorders being more common among treated females (83% vs. 71%) and other substance use disorders more common among treated males (68% vs. 63%). Among patients with a single mental health condition comorbid with opioid use disorder, females were less likely than males to receive medication treatment for opioid use disorder (15% vs. 20%, respectively).
    Conclusions: The high rate of comorbid conditions among patients with opioid use disorder indicates a strong need to supply primary care providers with adequate resources for integrated opioid use disorder treatment.
    MeSH term(s) Humans ; Female ; Male ; Adolescent ; Retrospective Studies ; Sex Characteristics ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/diagnosis ; Buprenorphine/therapeutic use ; Mental Disorders/drug therapy ; Mental Disorders/epidemiology ; Primary Health Care ; Analgesics, Opioid/therapeutic use
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
    Language English
    Publishing date 2022-06-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1220173-x
    ISSN 1557-9700 ; 1075-2730
    ISSN (online) 1557-9700
    ISSN 1075-2730
    DOI 10.1176/appi.ps.202100665
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 416: Show issues Location:
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  4. Article ; Online: Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial.

    Wartko, Paige D / Bobb, Jennifer F / Boudreau, Denise M / Matthews, Abigail G / McCormack, Jennifer / Lee, Amy K / Qiu, Hongxiang / Yu, Onchee / Hyun, Noorie / Idu, Abisola E / Campbell, Cynthia I / Saxon, Andrew J / Liu, David S / Altschuler, Andrea / Samet, Jeffrey H / Labelle, Colleen T / Zare-Mehrjerdi, Mohammad / Stotts, Angela L / Braciszewski, Jordan M /
    Murphy, Mark T / Dryden, Douglas / Arnsten, Julia H / Cunningham, Chinazo O / Horigian, Viviana E / Szapocznik, José / Glass, Joseph E / Caldeiro, Ryan M / Phillips, Rebecca C / Shea, Mary / Bart, Gavin / Schwartz, Robert P / McNeely, Jennifer / Liebschutz, Jane M / Tsui, Judith I / Merrill, Joseph O / Lapham, Gwen T / Addis, Megan / Bradley, Katharine A / Ghiroli, Megan M / Hamilton, Leah K / Hu, Yong / LaHue, Jennifer S / Loree, Amy M / Murphy, Sean M / Northrup, Thomas F / Shmueli-Blumberg, Dikla / Silva, Angela J / Weinstein, Zoe M / Wong, Mark TinFook / Burganowski, Rachael P

    JAMA internal medicine

    2023  Volume 183, Issue 12, Page(s) 1343–1354

    Abstract: Importance: Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments.: Objective: To assess whether implementation of the Massachusetts model of nurse care management ... ...

    Abstract Importance: Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments.
    Objective: To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization.
    Design, setting, and participants: The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after.
    Intervention: The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine.
    Main outcomes and measures: The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up.
    Results: During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70).
    Conclusions and relevance: The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD.
    Trial registration: ClinicalTrials.gov Identifier: NCT03407638.
    MeSH term(s) Humans ; Female ; Middle Aged ; Adolescent ; Young Adult ; Adult ; Aged ; Aged, 80 and over ; Male ; Naltrexone/therapeutic use ; Opiate Substitution Treatment/methods ; Leadership ; Opioid-Related Disorders/drug therapy ; Buprenorphine/therapeutic use
    Chemical Substances Naltrexone (5S6W795CQM) ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2023-10-30
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2023.5701
    Database MEDical Literature Analysis and Retrieval System OnLINE

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