Lois Lamerato

Henry Ford Health System, Detroit, Michigan, United States

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Publications (82)313.09 Total impact

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    ABSTRACT: The Chronic Hepatitis Cohort Study (CHeCS) is a longitudinal observational study of risks and benefits of treatments and care in patients with chronic hepatitis B (HBV) and C (HCV) infection from four US health systems. We hypothesized that comparative effectiveness methods-including a centralized data management system and an adaptive approach for cohort selection-would improve cohort selection while controlling data quality and reducing the cost.
    Digestive Diseases and Sciences 07/2014; · 2.26 Impact Factor
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    ABSTRACT: Identify predictors of non-compliance with first round screening exams in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.
    Preventive medicine. 07/2014;
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    ABSTRACT: One year of trastuzumab therapy is recommended for women with HER2-positive breast cancer ≥1.0 cm in size to increase survival and is considered for women with tumors 0.5-0.9 cm in size. We analyzed compliance with trastuzumab among women with HER2-positive breast cancer in a prospective cohort study. Of 1145 recruited patients with breast cancer, 152 were HER2-positive (13.2 %), of whom 126 had tumors ≥1.0 cm; 110/126 (87.3 %) of these initiated trastuzumab. Non-receipt was associated with older age, better prognosis tumors, and with non-receipt of adjuvant chemotherapy. Of the 110 who initiated treatment, 18 (15 %) did not complete treatment, 15 (83 %) of them because of cardiotoxicity. Of 20 women with tumors 0.5-0.9 cm, 5 (25 %) initiated trastuzumab. Compliance with trastuzumab was very high among those with HER2-positive breast cancer, as was the completion of the recommended therapy.
    Breast Cancer 06/2014; · 1.33 Impact Factor
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    ABSTRACT: The purpose of this study was to analyze the prognostic significance of sociodemographic factors on biochemical control (bNED) and overall survival (OS) in patients with prostate cancer.
    American journal of clinical oncology. 05/2014;
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    ABSTRACT: We evaluated whether prior infection with the hepatitis B virus (HBV) influences the development of pancreatic cancer or hepatocellular carcinoma (HCC). Prior infection with HBV may predispose patients to developing pancreatic cancer or HCC. We conducted a retrospective cohort study using administrative data from an integrated health care system. We identified all patients who had HBV testing over a 13-year period. These patients were divided into 1 of 3 cohorts based on HBV status: negative infection (n=28,719), previous exposure (n=5141), or active infection (n=404). Pancreatic cancer and HCC data were obtained from pathology reports in the health system's cancer registry. In a multivariable model, age [hazards ratio (HR), 1.08; confidence interval (CI), 1.06-1.09; P<0.001)] and presence of diabetes (HR, 1.88; CI, 1.27-2.80; P=0.002) were identified to have significant influence on pancreatic cancer development, whereas previous HBV exposure did not have a significant influence (HR, 1.41; CI, 0.88-2.27; P=0.16). In a separate multivariable model, male sex (HR, 2.05; CI, 1.35-3.11; P<0.001), age (HR, 1.08; CI, 1.06-1.09; P<0.001), being hepatitis C positive (HR, 5.40; CI, 3.51-8.33; P<0.001), and presence of cirrhosis (HR, 27.84; CI, 17.43-44.46, P<0.001) were all significant predictors of HCC. However, previous HBV exposure was not associated with HCC development (HR, 1.03; CI, 0.68-1.56; P=0.88). Data from this study indicate that previous HBV exposure is not a risk factor for the development of either pancreatic cancer or HCC.
    Journal of clinical gastroenterology 03/2014; · 2.21 Impact Factor
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    ABSTRACT: While health insurance claims data are often used to estimate the costs of renal replacement therapy in patients with end-stage renal disease (ESRD), the accuracy of methods used to identify patients receiving dialysis - especially peritoneal dialysis (PD) and hemodialysis (HD) - in these data is unknown. The study population consisted of all persons aged 18 - 63 years in a large US integrated health plan with ESRD and dialysis-related billing codes (i.e., diagnosis, procedures) on healthcare encounters between January 1, 2005, and December 31, 2008. Using billing codes for all healthcare encounters within 30 days of each patient's first dialysis-related claim ("index encounter"), we attempted to designate each study subject as either a "PD patient" or "HD patient." Using alternative windows of ± 30 days, ± 90 days, and ± 180 days around the index encounter, we reviewed patients' medical records to determine the dialysis modality actually received. We calculated the positive predictive value (PPV) for each dialysis-related billing code, using information in patients' medical records as the "gold standard." We identified a total of 233 patients with evidence of ESRD and receipt of dialysis in healthcare claims data. Based on examination of billing codes, 43 and 173 study subjects were designated PD patients and HD patients, respectively (14 patients had evidence of PD and HD, and modality could not be ascertained for 31 patients). The PPV of codes used to identify PD patients was low based on a ±30-day medical record review window (34.9%), and increased with use of ± 90-day and ± 180-day windows (both 67.4%). The PPV for codes used to identify HD patients was uniformly high - 86.7% based on ± 30-day review, 90.8% based on ± 90-day review, and 93.1% based on ±180-day review. While HD patients could be accurately identified using billing codes in healthcare claims data, case identification was much more problematic for patients receiving PD.
    Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 02/2014;
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    ABSTRACT: The purpose of this paper is to document the use of intravenous (IV) bisphosphonates for prevention of skeletal-related events (SREs) in patients with bone metastases (BM) due to breast cancer (BC), lung cancer (LC), or prostate cancer (PC). Using data from two large US health systems, we identified all patients aged ≥18 years with primary BC, LC, or PC and newly diagnosed BM between 1/1/1995 and 12/31/2009. Starting with the diagnosis of BM, we reviewed medical and administrative records for evidence of receipt of IV bisphosphonates (zoledronic acid or pamidronate) and occurrence of SREs. Initiation of IV bisphosphonates prior to occurrence of an SRE was designated "primary prophylaxis"; use following an SRE was designated "secondary prophylaxis". We identified a total of 1,193 patients with newly diagnosed BM, including 400 with BC, 332 with LC, and 461 with PC. Use of IV bisphosphonates was substantially higher in BC (55.8 % of all patients) than in LC (14.8 %) or PC (20.2 %). Use of IV bisphosphonates was fairly evenly split between primary and secondary prophylaxis in BC (26.3 vs. 29.5 %, respectively) and PC (10.6 vs 9.5 %); in LC, however, primary prophylaxis was much less common than secondary prophylaxis (4.8 vs 9.9 %). Almost one half of all patients with BM due to BC, and substantially more with LC and PC, do not receive IV bisphosphonates. Among patients receiving such therapy, treatment often is not initiated until after the occurrence of an SRE. Our study suggests that IV bisphosphonates may be substantially underutilized in patients with BM due to these common cancers.
    Supportive Care in Cancer 01/2014; · 2.09 Impact Factor
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    ABSTRACT: Background. Each year, the US Flu VE Network examines the effectiveness of influenza vaccines in preventing medically-attended acute respiratory illnesses caused by influenza. Methods. Patients with acute respiratory illnesses of <7 days duration were enrolled at ambulatory care facilities in five communities. Specimens were collected and tested for influenza by real-time reverse transcriptase polymerase chain reaction. Receipt of influenza vaccine was defined based on documented evidence of vaccination in medical records or immunization registries. Vaccine effectiveness was estimated in adjusted logistic regression models by comparing the vaccination coverage in those who tested positive for influenza with those who tested negative. Results. The 2011-2012 season was mild and peaked late, with circulation of both type A viruses and both lineages of type B. Overall adjusted vaccine effectiveness was 47% (95% confidence interval [CI], 36 to 56) in preventing medically-attended influenza; vaccine effectiveness was 65% (95% CI, 44 to 79) against type A (H1N1) pdm09, but only 39% (95% CI, 23 to 52) against type A (H3N2). Estimates of vaccine effectiveness against both type B lineages were similar (overall 58%, 95% CI, 35 to 73). An apparent negative effect of prior year vaccination on current year effectiveness estimates was noted, particularly for A (H3N2) outcomes. Conclusions. Vaccine effectiveness in the 2011-2012 season was modest overall, with lower effectiveness against the predominant A (H3N2) virus. This may be related to modest antigenic drift, but past history of vaccination might also play a role.
    Clinical Infectious Diseases 11/2013; · 9.37 Impact Factor
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    ABSTRACT: The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.Journal of Exposure Science and Environmental Epidemiology advance online publication, 13 November 2013; doi:10.1038/jes.2013.78.
    Journal of Exposure Science and Environmental Epidemiology 11/2013; · 3.19 Impact Factor
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    ABSTRACT: Antiviral therapy could reduce the risk of hepatocellular carcinoma (HCC) among persons with chronic hepatitis B (HBV) infection. We evaluated the relationship between therapy for chronic HBV infection and HCC incidence using data from a longitudinal study of patients at 4 US healthcare centers. We analyzed electronic health records of 2671 adult participants in the Chronic Hepatitis Cohort Study who were diagnosed with chronic HBV infection from 1992 through 2011 (49% Asian). Data analyzed were collected for a median of 5.2 y. Propensity-score adjustment was used to reduce bias, and Cox regression was used to estimate the relationship between antiviral treatment and HCC. The primary outcome was time to event of HCC incidence. Of study subjects, 3% developed HCC during follow-up period: 20 cases among the 820 patients with a history of antiviral HBV therapy and 47 cases among the 1851 untreated patients. In propensity-adjusted Cox regression, patients who received antiviral therapy had a lower risk of HCC those who did not (adjusted hazard ratio [aHR], 0.39; 95% confidence interval [CI], 0.27-0.56; P<.001), after adjusting for abnormal level of alanine aminotransferase. In a subgroup analysis, antiviral treatment was associated with a lower risk of HCC after adjusting for serum markers of cirrhosis (aHR, 0.24; 95% CI, 0.15-0.39; P<.001). In a separate subgroup analysis of patients with available data on HBV DNA viral load, treated patients with viral loads >20,000 IU/mL had a significantly lower risk of HCC than untreated patients with viral loads >20,000 IU/mL. In a large geographically, clinically, and racially diverse US cohort, antiviral therapy for chronic HBV infection was associated with a reduced risk for HCC.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2013; · 5.64 Impact Factor
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    ABSTRACT: Background/Aims Accurate EMR-based cohort identification is crucial in the conduct of comparative effectiveness research. CheCS is a longitudinal study of chronic hepatitis B (CHB) and C (CHC) infection being conducted at 4 HMORN sites. Subjects are identified using automated EMR-based ICD-9 diagnosis and laboratory inclusion criteria, and about 12,000 patients were identified in the initial cohort selection. After confirmation of CHB/ CHC status through chart abstraction, we found false discovery rates (FDR) were 13.6% for CHB and 11.3% for CHC. An adaptive approach was proposed to optimize the EMR-based cohort selection. Methods Classification and Regression Tree (CART) was performed to identify a set of electronic variables (or variable combinations) for CHB and CHC. The variables/classifiers that were considered included not only all the initial cohort identificaton criteria, but also HIV status, any outpatient order or pharmacy claim for CHB/CHC antiviral medication, and 41 other liver disease-related procedures/diagnoses. The analysis began with CART model building using one set of data (learning), followed by model validation using the other set of data (testing). Results Of the 12,144 patients identified for the initial CHeCS cohort, 2518 met initial CHB criteria and 9844 met initial CHC criteria, including 218 who met criteria for both. Of these, 10,825 (2176 CHB and 8724 CHC, including 75 co-infected) patients' diagnoses were confirmed through chart abstraction and the remaining were excluded. CART model FDRs were 8.5% on learning data and 7.1% on testing data for CHB, and 4.9% and 5.7% for CHC, yielding sensitivities and specificities >91% for CHB and >84% for CHC. Overall, FDRs were significantly lower (7.8% for CHB, 5.3% for CHC) than those yielded from the initial inclusion criteria alone (P <0.001). Conclusions Our adaptive approach to using electronic data for prediction of CHB/CHC status is feasible, can be used for sequential CHeCS cohort identification, and may be useful in other studies to identify patients diagnosed with CHB/CHC.
    Clinical Medicine &amp Research 09/2013; 11(3):143.
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    ABSTRACT: To document the risk of skeletal complications in patients with bone metastases from breast cancer (BC), lung cancer (LC), or prostate cancer (PC) in routine clinical practice. We used data from two large US health systems to identify patients aged ≥18 years with primary BC, LC, or PC and newly diagnosed bone metastases between January 1, 1995 and December 31, 2009. Beginning with the date of diagnosis of bone metastasis, we estimated the cumulative incidence of skeletal-related events (SREs) (spinal cord compression, pathologic fracture, radiation to bone, bone surgery), based on review of medical records, accounting for death as a competing risk. We identified a total of 621 BC, 477 LC, and 721 PC patients with newly diagnosed bone metastases. SREs were present at diagnosis of bone metastasis in 22.4, 22.4, and 10.0 % of BC, LC, and PC patients, respectively. Relatively few LC or PC patients received intravenous bisphosphonates (14.8 and 20.2 %, respectively); use was higher in patients with BC, however (55.8 %). In BC, cumulative incidence of SREs during follow-up was 38.7 % at 6 months, 45.4 % at 12 months, and 54.2 % at 24 months; in LC, it was 41.0, 45.4, and 47.7 %; and in PC, it was 21.5, 30.4, and 41.9 %. More than one half of patients with bone metastases had evidence of SREs (BC: 62.6 %; LC: 58.7 %; PC: 51.7 %), either at diagnosis of bone metastases or subsequently. SREs are a frequent complication in patients with solid tumors and bone metastases, and are much more common than previously recognized in women with BC.
    Supportive Care in Cancer 07/2013; · 2.09 Impact Factor
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    ABSTRACT: Background. Liver biopsy remains critical for staging liver disease in hepatitis C virus (HCV)-infected persons, but is a bottleneck to evaluation, follow-up and treatment of HCV. Our analysis sought to validate 'APRI' (aspartate aminotransferase [AST]-to-platelet ratio index) and 'FIB-4,' an index from serum fibrosis markers (alanine aminotransferase [ALT], AST, and platelets plus patient age) to stage liver disease. Methods. Biopsy results from HCV patients in the Chronic Hepatitis Cohort Study ('CHeCS') were mapped to a F0-F4 equivalent scale; APRI and FIB-4 scores at the time of biopsy were then mapped to the same scale. Results. We identified 2,372 liver biopsies from HCV-infected patients with contemporaneous laboratory values for imputing APRI and FIB-4. Fibrosis stage distributions by the equivalent biopsy scale were: 267 (11%) F0; 555 (23%) F1; 648 (27%) F2; 394 (17%) F3; and 508 (21%) F4. Mean APRI and FIB-4 values significantly increased with successive fibrosis levels (p<0.05). The areas under the curves using receiver operating characteristic curves (AUROC) analysis distinguishing severe (F3-F4) from mild-to-moderate fibrosis (F0-F2) were: 0.80 (0.78, 0.82) for APRI; and 0.83 (0.81, 0.85) for FIB-4. There was a significant difference between the AUROCs of FIB-4 and APRI (p<0.001); 88% of persons who had a FIB-4 score>2.0 were at stage F2 or higher. Conclusion. In a large observational cohort, FIB-4 was good at differentiating five stages of chronic HCV infection. It can be useful: in screening patients who need biopsy and therapy; for monitoring less advanced disease patients; and for longitudinal studies.
    Clinical Infectious Diseases 04/2013; · 9.37 Impact Factor
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    ABSTRACT: Background Little is known about the development of posttraumatic stress disorder (PTSD) over time among women diagnosed with breast cancer. This study examines changes in PTSD symptoms in the first 6 months after diagnosis and assesses racial/ethnic differences in PTSD symptomatology over time.Methods We recruited women with newly diagnosed breast cancer, stages I to III, from three sites in the United States. Three telephone interviews were conducted: baseline at about 2 to 3 months after diagnosis, first follow-up at 4 months after diagnosis, and second follow-up at 6 months after diagnosis. We measured traumatic stress in each interview using the Impact of Events Scale; recorded sociodemographic, tumor, and treatment factors; and used generalized estimating equations and polytomous logistic regression modeling to examine the associations between variables of interest and PTSD.ResultsOf 1139 participants, 23% reported symptoms consistent with a diagnosis of PTSD at baseline, 16.5% at first follow-up, and 12.6% at the second follow-up. Persistent PTSD was observed among 12.1% participants, as defined by having PTSD at two consecutive interviews. Among participants without PTSD at baseline, 6.6% developed PTSD at the first follow-up interview. Younger age at diagnosis, being black (odds ratio [OR] = 1.48 vs white, 95% confidence interval [CI] =1.04 to 2.10), and being Asian (OR = 1.69 vs white, 95% CI = 1.10 to 2.59) were associated with PTSD.Conclusions Nearly one-quarter of women newly diagnosed with breast cancer reported symptoms consistent with PTSD shortly after diagnosis, with increased risk among black and Asian women. Early identification of PTSD may present an opportunity to provide interventions to manage symptoms.
    CancerSpectrum Knowledge Environment 02/2013; · 14.07 Impact Factor
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    ABSTRACT: Patients are increasingly involved in cancer treatment decisions and yet little research has explored factors that may affect patient attitudes and beliefs about their therapeutic choices. This paper examines psychosocial factors (e.g., attitudes, social support), provider-related factors (e.g., communication, trust), and treatment considerations in a prospective study of a sample of non-metastatic breast cancer patients eligible for chemotherapy and/or hormonal therapy (BQUAL cohort). The data come from a multisite cohort study of white, black, Hispanic, and Asian non-metastatic breast cancer patients recruited in New York City, Northern California, and Detroit, Michigan. Baseline surveys were conducted over the telephone between 2006 and 2010 among a total of 1,145 women. Most participants were white (69 %), had more than a high school education (76 %), and were diagnosed with stage I disease (51 %). The majority of women reported discussing chemotherapy and hormonal therapy with their doctor (90 and 83 %, respectively); these discussions primarily took place with medical oncologists. Nearly a quarter of women reported that the treatment decision was difficult, and the majority were accompanied to the doctor (76 %) and involved a friend or family member in making the decision (54 %). Positive considerations (e.g., beliefs about treatment reducing risk of recurrence) were important in making treatment decisions. Participants preferred a shared decision-making style, but results suggested that there is room for improvement in terms of actual patient's involvement in making the decision and provider communication, particularly among black patients. Patients 65 years and older reported fewer provider discussions of chemotherapy, poorer patient-provider communication, higher rates of being assisted by family members in making the decision, and more negative attitudes and beliefs toward treatment.
    Breast Cancer Research and Treatment 12/2012; · 4.47 Impact Factor
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    ABSTRACT: PURPOSE: Shared breast cancer treatment decision-making between patients and physicians increases patient treatment satisfaction and compliance and is influenced by physician-related factors. Attitudes and behaviors about patient involvement in breast cancer treatment decisions and treatment-related communication were assessed by specialty among breast cancer physicians of women enrolled in the Breast Cancer Quality of Care Study (BQUAL). RESULTS: Of 275 BQUAL physicians identified, 50.0% responded to the survey. Most physicians spend 46-60 min with the patient during the initial consult visit and 51.5% report that the treatment decision is made in one visit. Oncologists spend more time with new breast cancer patients during the initial consult (p = 0.021), and find it more difficult to handle their own feelings than breast surgeons (p = <0.001). CONCLUSION: Breast surgeons and oncologists share similar attitudes and behaviors related to patient involvement in treatment decision-making, yet oncologists report more difficulty managing their own feelings during the decision-making process.
    Breast (Edinburgh, Scotland) 10/2012; · 2.09 Impact Factor
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    ABSTRACT: PURPOSEFor some women, adjuvant chemotherapy for nonmetastatic breast cancer decreases recurrences and increases survival; however, patient-physician decisions regarding chemotherapy receipt can be influenced by medical and nonmedical factors. PATIENTS AND METHODS We used a prospective cohort design and multivariate modeling to investigate factors related to noninitiation of chemotherapy among women with newly diagnosed breast cancer recruited from three US sites. We interviewed patients at baseline and during treatment on sociodemographic, tumor, and treatment decision-making factors. Patients were categorized according to National Comprehensive Cancer Network guidelines as those for whom chemotherapy was definitely indicated, clinically discretionary, or discretionary based on age greater than 70 years.ResultsOf 1,145 patients recruited, chemotherapy was clinically indicated for 392 patients, clinically discretionary for 459 patients, discretionary because of age for 169 patients, and not indicated for 93 patients; data were insufficient for 32 patients. Chemotherapy rates were 90% for those in whom chemotherapy was clinically indicated, 36% for those in whom it was discretionary because of clinical factors, and 19% for those in whom it was discretionary based on age greater than 70 years. Nonreceipt of chemotherapy was associated with older age, more negative beliefs about treatment efficacy, less positive beliefs about chemotherapy, and more concern about adverse effects. In the two discretionary groups, clinical predictors of worse outcome (greater tumor size, positive nodes, worse grade, and estrogen receptor- and progesterone receptor-negative status) were associated with increased chemotherapy initiation. CONCLUSION Utilization of adjuvant chemotherapy was most common among patients who, based on clinical criteria, would most likely benefit from it, patients with more positive than negative beliefs regarding treatment efficacy, and patients with few concerns about adverse effects.
    Journal of Clinical Oncology 09/2012; · 18.04 Impact Factor
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    ABSTRACT: In clinical practice, adherence with bisphosphonate therapy varies greatly among women with osteoporosis or osteopenia. Our study suggests that better adherence with bisphosphonates confers tangible benefits in terms of graded increases in bone mineral density. Interventions to improve drug adherence should be an important component of disease management. INTRODUCTION: In clinical trials, bisphosphonates have been found to increase bone mineral density (BMD) in women with osteoporosis or osteopenia. In clinical practice, where drug adherence is more variable, change in BMD with bisphosphonate therapy-overall and by level of adherence-is largely unknown. METHODS: A retrospective cohort study was conducted at Henry Ford Health System (Detroit, MI, USA). Study subjects were women who had low BMD at the left total hip (T-score < -1.0), began oral bisphosphonate therapy, and had ≥1 BMD measurements at the left total hip ≥6 months following treatment initiation. Change in BMD was calculated between the most recent pretreatment scan and the first follow-up scan. Adherence (i.e., medication possession ratio (MPR)) was measured from therapy initiation to the first follow-up scan. RESULTS: Among 644 subjects, mean age was 66 years, pretreatment BMD was 0.73 g/cm(2), and pretreatment T-score was -1.8. Over a mean follow-up of 27.1 months, mean MPR was 0.57 (95 % CI, 0.54 and 0.59), and mean percentage change in BMD was 1.5 % (1.1 and 1.9 %). Within the MPR strata (five consecutive equi-intervals, from low (0-0.19) to high (0.80-1.0)), mean change in BMD was -0.8 % (-1.6 and 0.1 %), 0.7 % (-0.3 and 1.7 %), 2.1 % (1.1 and 3.0 %), 2.1 % (1.4 and 2.9 %), and 2.9 % (2.3 and 3.5 %), respectively. In adjusted analyses, percentage change in BMD was higher (by 1.4-3.4 %, p < 0.05 for all) in the highest four MPR intervals, respectively, versus MPR 0-0.19. CONCLUSIONS: Among women with osteoporosis or osteopenia in clinical practice, better adherence with bisphosphonates appears to confer tangible benefits in terms of increases in BMD.
    Osteoporosis International 08/2012; · 4.04 Impact Factor
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    Rick Krajenta, Lois Lamerato, Karen Wells
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    ABSTRACT: Background Healthcare utilization data, specifically diagnoses and procedures, can be processed through different administrative systems. Billing data are generated by the care provider while claims data are generated by the payer. These two sources can represent the data content differently and incorporating the data from these systems into the VDW has presented a unique set of challenges. We present options for reconciling these two data sources to create a VDW that includes all patients including those outside of the HMO member realm. Methods Henry Ford Health System (HFHS) captures patients, care providers, procedures, diagnoses and medical supply information through a proprietary system. Outpatient billing information is entered by clinic staff using an optical scanning device and clinic-specific forms. Other additional procedures and/or supplies are entered into the system using a transaction capture application. Ancillary services such as imaging and pathology are imported into the billing system from their proprietary information systems. The main function of this system is to generate bills for services performed. The data elements are standardized to contain required justification for reimbursement from all payer types. Standard codes sets, ICD9, HCPCS and CPT4, are required. The data can also be used to evaluate workload and staffing levels, project future needs and characterize trends in service demands. HFHS uses this data source to build VDW files. Results Major differences between claims and billing data exist. Claims data are based on health plan contract with bundled procedures, coverage exclusions and deductibles affecting content. Billing data are based solely on services provided. The potential for overwhelming amounts of data in billing sources is possible due to the level of detail; however, this same level of detail is a rich source for specific care components that would not otherwise be present in claims records. Conclusion Billing data are less likely to be compromised by contract restrictions, bundling of different procedures under one code or rejected payments. It is often more granular than claims-based data. Billing data is a reliable source for the VDW utilization data area because it is a more accurate representation of the delivery of health care.
    Clinical Medicine &amp Research 08/2012; 10(3):197.
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    ABSTRACT: Studies of breast cancer outcomes rely on the identification of second breast cancer events (recurrences and second breast primary tumors). Cancer registries often do not capture recurrences, and chart abstraction can be infeasible or expensive. An alternative is using administrative health-care data to identify second breast cancer events; however, these algorithms must be validated against a gold standard. We developed algorithms using data from 3152 women in an integrated health-care system who were diagnosed with stage I or II breast cancer in 1993-2006. Medical record review served as the gold standard for second breast cancer events. Administrative data used in algorithm development included procedures, diagnoses, prescription fills, and cancer registry records. We randomly divided the cohort into training and testing samples and used a classification and regression tree analysis to build algorithms for classifying women as having or not having a second breast cancer event. We created several algorithms for researchers to use based on the relative importance of sensitivity, specificity, and positive predictive value (PPV) in future studies. The algorithm with high specificity and PPV had 89% sensitivity (95% confidence interval [CI] = 84% to 92%), 99% specificity (95% CI = 98% to 99%), and 90% PPV (95% CI = 86% to 94%); the high-sensitivity algorithm had 96% sensitivity (95% CI = 93% to 98%), 95% specificity (95% CI = 94% to 96%), and 74% PPV (95% CI = 68% to 78%). Algorithms based on administrative data can identify second breast cancer events with high sensitivity, specificity, and PPV. The algorithms presented here promote efficient outcomes research, allowing researchers to prioritize sensitivity, specificity, or PPV in identifying second breast cancer events.
    CancerSpectrum Knowledge Environment 04/2012; 104(12):931-40. · 14.07 Impact Factor

Publication Stats

927 Citations
313.09 Total Impact Points


  • 2001–2014
    • Henry Ford Health System
      • Department of Public Health Sciences
      Detroit, Michigan, United States
  • 2013
    • Centers for Disease Control and Prevention
      • Division of Viral Hepatitis
      Atlanta, Michigan, United States
  • 2012
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2005–2012
    • Columbia University
      • • College of Physicians and Surgeons
      • • Department of Medicine
      New York City, NY, United States
  • 2006–2011
    • Henry Ford Hospital
      Detroit, Michigan, United States
  • 2010
    • Tulane University
      • Department of Medicine
      New Orleans, LA, United States
    • National Institutes of Health
      • Division of Extramural Activities
      Bethesda, MD, United States
    • Howard University
      • Department of Medicine
      Washington, WV, United States
  • 2008
    • Medical University of South Carolina
      • Division of Biostatistics and Epidemiology
      Charleston, SC, United States
  • 2004
    • University of Southern California
      • Keck School of Medicine
      Los Angeles, California, United States