Lisa H Gren

University of Utah, Salt Lake City, Utah, United States

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Publications (15)21.57 Total impact

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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: We investigated emergency physician knowledge of the Centers for Medicare & Medicaid Services (CMS) reimbursement for common tests ordered and procedures performed in the emergency department (ED), determined the relative accuracy of their estimation, and reported the impact of perceived costs on physicians' ordering and prescribing behavior. We distributed an online survey to 189 emergency physicians in 11 EDs across multiple institutions. The survey asked respondents to estimate reimbursement rates for a limited set of medical tests and procedures, rate their level of current cost knowledge, and determine the effect of health expenditures on their medical decision making. We calculated relative accuracy of cost knowledge as a percent difference of participant estimation of cost from the CMS reimbursement rate. Ninety-seven physicians participated in the study. Most respondents (65%) perceived their knowledge of costs as inadequate, and 39.3% indicated that beliefs about cost impacted their ordering behavior. Eighty percent of physicians surveyed were unable to estimate 25% of the costs within ±25%, and no physicians estimated at least 50% of costs within 25% of the CMS reimbursement and only 17.3% of medical services were estimated correctly within ±25% by 1 or more physicians. Most emergency physicians indicated they should consider cost in their decision making but have a limited knowledge of cost estimates used by CMS to calculate reimbursement rates. Interventions that are easily accessible and applicable in the ED setting are needed to educate physicians about costs, reimbursement, and charges associated with the care they deliver.
    The American journal of emergency medicine 02/2014; · 1.54 Impact Factor
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    ABSTRACT: Background: To date, no physical activity (PA) questionnaires intended for primary care have been compared against a criterion measure of PA and current (2008) aerobic PA recommendations of the American College of Sports Medicine/American Heart Association (ACSM/AHA). Aim: This study evaluated preliminary evidence for criterion validity of two brief (<1 min) PA questionnaires with accelerometry, and their ability to identify if individuals meet ACSM/AHA PA recommendations. Methods: 45 health clinic staff wore an accelerometer for seven consecutive days and afterwards completed two brief PA questionnaires, the Physical Activity Vital Sign (PAVS), and the Speedy Nutrition and Physical Activity Assessment (SNAP). Agreement and descriptive statistics were calculated between the PAVS or SNAP and accelerometry in order to measure each questionnaire's ability to quantify the number of days participants achieved ⩾30 min of moderate-vigorous PA (MVPA) performed in bouts of ⩾10 continuous minutes. Participants with <5 days of ⩾30 bout-min of MVPA were considered insufficiently active according to PA recommendations. Findings: There was a significant positive correlation between number of days with ⩾30 bout-min MVPA and the PAVS (r=0.52, P<0.001), and SNAP (r=0.31, P<0.05). The PAVS had moderate agreement with accelerometry for identifying if individuals met or did not meet PA recommendations (κ=0.46, P<0.001), whereas SNAP had poor agreement (κ=0.12, P<0.05). Conclusions: This study provides preliminary evidence of criterion validity of the PAVS and SNAP with accelerometry and agreement identifying if respondents meet current (2008) ACSM/AHA aerobic PA recommendations. The PAVS and SNAP should be evaluated further for repeatability, and in populations varying in PA levels, age, gender, and ethnicity.
    Primary Health Care Research & Development 01/2014;
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    ABSTRACT: BACKGROUND: Rural women in West Bengal have been found to have low rates of formal education, poor health knowledge, high rates of malnutrition and anemia, and low levels of empowerment. Despite these difficult circumstances, some women have positive health outcomes compared to women with similarly disadvantaged backgrounds. The purpose of this study is to identify factors associated with positive health outcomes among women with primary education or less. METHODS: Multivariable regression models were built for outcomes of positive deviance to better characterize the factors in a woman's life that most impact her ability to deviate from the status quo. RESULTS: Positive deviants in this context are shown to be women who are able to earn an income, who have access to information through media sources, and who, despite little schooling, have marginally higher levels of formal education that lead to improved health outcomes. CONCLUSIONS: Study findings indicate that positive deviant women in disadvantaged circumstances can achieve positive outcomes amidst a host of contextual barriers that would predict poor health outcomes. Focusing on areas such as enhancing access to media sources, facilitating self-help groups for married women, and promoting prolonged education and delayed marriage for girls may improve health knowledge and behavior among married women with low levels of education.
    BMC Public Health 04/2013; 13(1):372. · 2.08 Impact Factor
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    ABSTRACT: The period of adolescence is a critical time of development. There is an urgent need to better assess adolescent health worldwide, particularly in India, a country with the world's largest adolescent population. Validated screening tools are needed to evaluate health-related risks and behaviors in this growing demographic. We developed, validated and administered a school-based health assessment, the Indian Adolescent Health Questionnaire, which can be used as a comprehensive health-screening tool among Indian adolescents in secondary school.
    Journal of Tropical Pediatrics 02/2013; · 1.01 Impact Factor
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    ABSTRACT: Objectives. Disease surveillance combines data collection and analysis with dissemination of findings to decision makers. The timeliness of these activities affects the ability to implement preventive measures. Influenza surveillance has traditionally been hampered by delays in both data collection and dissemination. Methods. We used statistical process control (SPC) to evaluate the daily percentage of outpatient visits with a positive point-of-care (POC) influenza test in the University of Utah Primary Care Research Network. Results. Retrospectively, POC testing generated an alert in each of 4 seasons (2004-2008, median 16 days before epidemic onset), suggesting that email notification of clinicians would be 9 days earlier than surveillance alerts posted to the Utah Department of Health website. In the 2008-09 season, the algorithm generated a real-time alert 19 days before epidemic onset. Clinicians in 4 intervention clinics received email notification of the alert within 4 days. Compared with clinicians in 6 control clinics, intervention clinicians were 40% more likely to perform rapid testing (P = 0.105) and twice as likely to vaccinate for seasonal influenza (P = 0.104) after notification. Conclusions. Email notification of SPC-generated alerts provided significantly earlier notification of the epidemic onset than traditional surveillance. Clinician preventive behavior was not significantly different in intervention clinics.
    Influenza research and treatment. 01/2013; 2013:242970.
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    ABSTRACT: Many clinical trials rely on participant report to first learn about study events. It is therefore important to have current contact information and the ability to locate participants should information become outdated. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and the Lung Screening Study (LSS) component of the National Lung Screening Trial, two large randomized cancer screening trials, enrolled almost 190,000 participants on whom annual contact was necessary. Ten screening centers participated in both trials. Centers developed methods to track participants and trace them when necessary. We describe the methods used to keep track of participants and trace them when lost, and the extent to which each method was used. Screening center coordinators were asked, using a self-administered paper questionnaire, to rate the extent to which specific tracking and tracing methods were used. Many methods were used by the screening centers, including telephone calls, mail, and internet searches. The most extensively used methods involved telephoning the participant on his or her home or cell phone, or telephoning a person identified by the participant as someone who would know about the participant's whereabouts. Internet searches were used extensively as well; these included searches on names, reverse-lookup searches (on addresses or telephone numbers) and searches of the Social Security Death Index. Over time, the percentage of participants requiring tracing decreased. Telephone communication and internet services were useful in keeping track of PLCO and LSS participants and tracing them when contact information was no longer valid.
    Contemporary clinical trials 04/2012; 33(4):601-5. · 1.51 Impact Factor
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    ABSTRACT: Risk factors, such as parental smoking, are commonly associated with increased asthma symptoms and hospitalizations of children. Deseret Mutual Benefits Administrators (DMBA) is the health insurer for employees of The Church of Jesus Christ of Latter-day Saints and their families. Due to religious proscription, employees abstain from alcohol and tobacco use, creating a cohort of children not exposed to parental smoking. Calculation of hospitalization rates for DMBA, Utah, and the US were made in children to compare rates between a nonsmoking population and general populations. Compared to DMBA, rate ratios for asthma hospitalization and emergency department asthma visits were higher for the US and Utah. The incidence of hospital outpatient department and physician office visits was significantly greater for the US population compared to the DMBA. This study demonstrates a decreased need for health services used by children not exposed to second-hand smoke.
    ISRN pediatrics. 01/2011; 2011:750213.
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    ABSTRACT: Healthcare claims data were used to better understand the diagnostic investigation and treatment of cancer. A retrospective cohort study was used involving claims data from a large insurance company. Analyses were based on electronic claims data from 1997 through 2006 for enrollees aged 15-64 years. This study showed that 96% of all first time cancer-related claims involved physician services. The percentage of physician services involving diagnostic workup in the form of some combination of blood testing, radiology, and surgery was 89% for non-skin cancer and 95% for skin cancer. The percentage of physician services involving some combination of chemotherapy, radiation, and surgery was 24% for non-skin cancer and 14% for skin cancer. Thus, for cancer (excluding skin cancer) the ratio of diagnostic workup to treatment was 2.7 to 1. For skin cancer, the ratio was 6.3 to 1. The percentage receiving treatment ranged from 13% for the male genital system to 46% for cancers of the bones and joints. Beyond cancers of the male or female genital systems, cancer-related claims involving treatment were 34% (95% CI 17-54%) higher for females than males. Healthcare claims data can be used to generate useful information for physicians and their patients about the process and nature of the diagnostic workups and treatment that typically occur when cancer is suspected.
    Medical science monitor: international medical journal of experimental and clinical research 05/2009; 15(5):PH25-31. · 1.22 Impact Factor
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    ABSTRACT: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001. Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail. Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success. In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was $9.64-35.38 for direct mail, excluding personnel costs. Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers. Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations.
    Clinical Trials 03/2009; 6(1):52-9. · 2.20 Impact Factor
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    ABSTRACT: This study describes the influence of attention deficit hyperactivity disorder (ADHD) on the incidence rates of selected injuries. A retrospective cohort study design was employed using medical claims data from the Deseret Mutual Benefit Administrators (DMBA), a health insurance company for employees of the Church of Jesus Christ of Latter-day Saints (LDS) and their spouses and dependent children. ADHD diagnosis, injury, medication, and demographic data were extracted from claims files during 1998-2005 for all enrollees aged 0-64 years. Incidence rates of ADHD were 1.83 (95% CI 1.68-2.00) times greater in males than females and highest in the age group 5-9 years and income group $80,000 or greater. ADHD increased the risk of selected injuries. The most common injuries involved sprains and strains of joints, then open wounds of the head, neck and trunk, and upper/lower limb, and then fractures of the upper/lower limb. Medication did not significantly protect against injury in ADHD patients. The rate of severe injury (i.e., fracture of skull, neck and trunk; intracranial injury excluding those with skull fracture; and injuries to nerves and spinal cord) was 3.07 (95% CI 2.37-3.98) times more common in ADHD enrollees compared with non-ADHD enrollees. Those with 1, 2, 3, or 4 or more injuries were 1.67 (1.50-1.86), 2.11 (1.75-2.56), 2.63 (1.80-3.84), and 2.94 (1.47-5.87) times more likely to have ADHD, respectively. ADHD is positively associated with injuries. More severe injuries have a significantly stronger associated with ADHD than less severe injuries.
    Advances in Medical Sciences 02/2009; 54(1):20-6. · 0.80 Impact Factor
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    ABSTRACT: The epidemiology of fibromyalgia is poorly defined. The incidence of fibromyalgia has not been determined using a large population base. Previous studies based on prevalence data demonstrated that females are 7 times more likely to have fibromyalgia than males and that the peak age for females is during the childbearing years. We have calculated the incidence rate of fibromyalgia in a large, stable population and determined the strength of association between fibromyalgia and 7 comorbid conditions. We conducted a retrospective cohort study of a large, stable health insurance claims database (62,000 nationwide enrollees per year). Claims from 1997 to 2002 were examined using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify fibromyalgia cases (ICD code 729.1) and 7 predetermined comorbid conditions. A total of 2595 incident cases of fibromyalgia were identified between 1997 and 2002. Age-adjusted incidence rates were 6.88 cases per 1000 person-years for males and 11.28 cases per 1000 person-years for females. Females were 1.64 times (95% confidence interval = 1.59-1.69) more likely than males to have fibromyalgia. Patients with fibromyalgia were 2.14 to 7.05 times more likely to have one or more of the following comorbid conditions: depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis. Females are more likely to be diagnosed with fibromyalgia than males, although to a substantially smaller degree than previously reported, and there are strong associations for comorbid conditions that are commonly thought to be associated with fibromyalgia.
    JCR Journal of Clinical Rheumatology 07/2006; 12(3):124-8. · 1.18 Impact Factor
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    ABSTRACT: A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0-682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24.6/1000 person-years, with a higher incidence among males and individuals aged 45-64 years. The most common site of infection was the lower extremity (39.9%). The majority of patients were seen in an outpatient setting (73.8%), and most (82.0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.
    Epidemiology and Infection 05/2006; 134(2):293-9. · 2.87 Impact Factor
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    ABSTRACT: Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.
    The Journal of Bone and Joint Surgery 04/2004; 86-A(4):743-7. · 3.23 Impact Factor
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    ABSTRACT: Osteoarthritis is both the most common form of arthritis and the most common reason for joint replacement surgery. Obese persons are believed to be more likely to develop generalized osteoarthritis that leads not only to knee but also to hip joint replacement surgeries. We hypothesized that obesity is also a risk for partial joint replacements and surgical revisions. A frequency-matched case-control study was conducted in Utah. Between 1992 and 2000, 840 hip and 911 knee joint replacement surgery patients, aged 55 to 74 years, were included in this study. Cases were randomly matched to 5578 controls, defined as Utah residents enrolled in a cancer screening trial. Odds ratios (ORs) were calculated using ICD-9 (International Classification of Diseases, 9th revision) procedural codes and body mass index (BMI) groups. There was a strong association between increasing BMI and both total hip and knee replacement procedures. In males, the highest OR was for those weighing 37.50 to 39.99 kg/m(2) (total hip: OR=9.37, 95% confidence interval [CI] 2.64-33.31; total knee: OR=16.40; 95% CI 5, 19-51.86). In females, the highest OR was for those weighing > or =40 kg/m(2) (total hip: OR=4.47; 95% CI, 2.13-9.37; total knee: OR=19.05; 95% CI, 9.79-37.08). There were slight gender-specific differences in risk found for partial hip replacement procedures. Unexpectedly, no statistically significant association was found between obesity and the risk for hip or knee revision procedures. While there is an association between obesity and hip and knee joint replacement surgeries, obesity does not appear to confer an independent risk for hip or knee revision procedures.
    American Journal of Preventive Medicine 11/2003; 25(4):290-5. · 3.95 Impact Factor