David J Magid

Kaiser Permanente, Oakland, California, United States

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Publications (270)2117.45 Total impact

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    ABSTRACT: Introduction: Self-monitoring of blood pressure is effective in reducing blood pressure in hypertension. However previous meta-analyses have shown a considerable amount of heterogeneity between studies, only part of which can be accounted for by meta-regression. This may be due to differences in design, recruited populations, intervention components or results among patient subgroups. To further investigate these differences, an individual patient data (IPD) meta-analysis of self-monitoring of blood pressure will be performed. Methods and analysis: We will identify randomised trials that have compared patients with hypertension who are self-monitoring blood pressure with those who are not and invite trialists to provide IPD including clinic and/ or ambulatory systolic and diastolic blood pressure at baseline and all follow-up points where both intervention and control groups were measured. Other data requested will include measurement methodology, length of followup, cointerventions, baseline demographic (age, gender) and psychosocial factors (deprivation, quality of life), setting, intensity of self-monitoring, self-monitored blood pressure, comorbidities, lifestyle factors (weight, smoking) and presence or not of antihypertensive treatment. Data on all available patients will be included in order to take an intention-to-treat approach. A twostage procedure for IPD meta-analysis, stratified by trial and taking into account age, sex, diabetes and baseline systolic BP will be used. Exploratory subgroup analyses will further investigate non-linear relationships between the prespecified variables. Sensitivity analyses will assess the impact of trials which have and have not provided IPD. Ethics and dissemination: This study does not include identifiable data. Results will be disseminated in a peer-reviewed publication and by international conference presentations. Conclusions: IPD analysis should help the understanding of which self-monitoring interventions for which patient groups are most effective in the control of blood pressure.
    BMJ Open 09/2015; 5(9):e008532. DOI:10.1136/bmjopen-2015-008532 · 2.27 Impact Factor
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    ABSTRACT: Introduction: Elevated blood pressure in childhood may predict increased cardiovascular risk in young adulthood. The Task Force on the Diagnosis, Evaluation and Treatment of High Blood pressure in Children and Adolescents recommends that blood pressure be measured in children aged 3 years or older at all health care visits. Guidelines from both Bright Futures and the Expert Panel of Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend annual blood pressure screening. Adherence to these guidelines is unknown. Methods: We conducted a cross-sectional study to assess compliance with blood pressure screening recommendations in 2 integrated health care delivery systems. We analyzed electronic health records of 103,693 subjects aged 3 to 17 years. Probability of blood pressure measurement documented in the electronic health record was modeled as a function of visit type (well-child vs nonwell-child); patient age, sex, race/ethnicity, and body mass index; health care use; insurance type; and type of office practice or clinic department (family practice or pediatrics). Results: Blood pressure was measured at 95% of well-child visits and 69% of nonwell-child outpatient visits. After adjusting for potential confounders, the percentage of nonwell-child visits with measurements increased linearly with patient age (P < .001). Overall, the proportion of children with annual blood pressure measurements was high and increased with age. Family practice clinics were more likely to adhere to blood pressure measurement guidelines compared with pediatric clinics (P < .001). Conclusion: These results show good compliance with recommendations for routine blood pressure measurement in children and adolescents. Findings can inform the development of EHR-based clinical decision support tools to augment blood pressure screening and recognition of prehypertension and hypertension in pediatric patients.
    Preventing chronic disease 07/2015; 12(7):E118. DOI:10.5888/pcd12.140562 · 2.12 Impact Factor
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    ABSTRACT: Whether there is a kidney function threshold to statin effectiveness in patients with acute myocardial infarction is poorly understood. Our study sought to help fill this gap in clinical knowledge. We undertook a new-user cohort study of the effectiveness of statin therapy by level of estimated glomerular filtration rate (eGFR) in adults who were hospitalized for myocardial infarction (MI) between 2000 and 2008. Data came from the Cardiovascular Research Network. The primary clinical outcomes were one-year all-cause mortality and cardiovascular hospitalizations, with adverse outcomes of myopathy and development of diabetes mellitus. We calculated incidence rates, the number needed to treat (NNT) and used Cox proportional hazards regression with propensity score matching and adjustment to control for confounding, with testing for variation of effect by level of kidney function. Compared with statin non-initiators (n=5,583), statin initiators (n=5,597) had a lower propensity score-adjusted risk for death (HR, 0.79; 95% Confidence Interval [CI], 0.71, 0.88) and cardiovascular hospitalizations (HR, 0.90; 95% CI, 0.82, 1.00). We found little evidence of variation in effect by level of eGFR (p=0.86 for death; p=0.77 for cardiovascular hospitalization). Adverse outcomes were similar for statin initiators and statin non-initiators. The NNT to prevent one additional death over 1 year of follow-up ranged from 15 (95% CI 11, 28) for eGFR <30 ml/min/1.73 m(2) requiring statin treatment over 2 years to prevent one additional death, to 67 (95% CI 49, 118) for patients with eGFR >90 ml/min/1.73m(2). Our findings suggest that there is potential for important public health gains by increasing the routine use of statin therapy for patients with lower levels of kidney function. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American journal of medicine 07/2015; DOI:10.1016/j.amjmed.2015.06.030 · 5.00 Impact Factor

  • The Journal of allergy and clinical immunology 06/2015; DOI:10.1016/j.jaci.2015.04.046 · 11.48 Impact Factor
  • Comilla Sasson · David J Magid ·

    New England Journal of Medicine 06/2015; 372(24):2349-50. DOI:10.1056/NEJMe1504659 · 55.87 Impact Factor

  • Journal of Vascular Surgery 06/2015; 61(6):160S-161S. DOI:10.1016/j.jvs.2015.04.305 · 3.02 Impact Factor
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    ABSTRACT: Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized. We studied 2954 patients with left ventricular ejection fraction ≤0.35 undergoing first-time implantable cardioverter-defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged >65 years. In a median follow-up of 2.4 years, outcome rates per 1000 patient-years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure-related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ratio 0.67, 95% CI 0.56 to 0.80) and heart failure hospitalization (hazard ratio 0.82, 95% CI 0.68 to 0.98) and higher risks for complications (hazard ratio 1.38, 95% CI 1.01 to 1.90) than men; patients aged >65 years had higher risks of death (hazard ratio 1.55, 95% CI 1.30 to 1.86) and heart failure hospitalization (hazard ratio 1.25, 95% CI 1.05 to 1.49) than younger patients. Age and sex differences were generally consistent in strata according to symptoms, etiology, and severity of left ventricular systolic dysfunction, except the higher risk of complications in women, which differed by New York Heart Association classification (P=0.03 for sex-New York Heart Association interaction), and the risk of heart failure hospitalization in older patients, which differed by etiology of heart failure (P=0.05 for age-etiology interaction). The burden of adverse outcomes after receipt of an implantable cardioverter-defibrillator for primary prevention is substantial and varies according to patient age and sex. These differences in outcome generally do not vary according to baseline heart failure characteristics. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
    Journal of the American Heart Association 05/2015; 4(6). DOI:10.1161/JAHA.115.002005 · 4.31 Impact Factor
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    ABSTRACT: Although the presence, extent, and severity of obstruction in patients with lower extremity peripheral artery disease (LE PAD) affect their functional status, quality of life, and treatment, it is not known if these factors are associated with future cardiovascular events. We empirically created an anatomic runoff score (ARS) to approximate the burden of LE PAD and determined its association with clinical outcomes. We evaluated all patients with LE PAD and bilateral angiography undergoing revascularization in a community-based clinical study. Primary clinical outcomes of interest were (1) a composite of all-cause death, myocardial infarction (MI), and stroke and (2) amputation-free survival. Cox proportional hazards models were created to identify predictors of clinical outcomes. We evaluated 908 patients undergoing angiography, and a total of 260 (28.0%) patients reached the composite end point (45 MI, 63 stroke, and 152 death) during the study period. Anatomic runoff score ranged from 0 to 15 (mean 4.7; SD 2.5) with higher scores indicating a higher burden of disease, and an optimal cutpoint analysis classified patients into low ARS (<5) and high ARS (≥5). The unadjusted rates of the primary composite end point and amputation-free survival were nearly 2-fold higher in patients with a high ARS when compared with patients with a low ARS. The most significant predictors of the composite end point (death/MI/stroke) were age (δ 10 years; hazard ratio [HR] 1.53; CI 1.32-1.78; P < .001), diabetes mellitus (HR 1.65; CI 1.26-2.18; P < .001), glomerular filtration rate <30 (HR 2.23; CI 1.44-3.44; P < .001), statin use (HR 0.66; CI 0.48-0.88; P < .001), and ARS (δ 2 points; HR 1.21; CI 1.08-1.35; P < .001). After adjustment for clinical factors, the LE PAD ARS was an independent predictor of future cardiovascular morbidity and mortality in a broadly representative patient population undergoing revascularization for symptomatic PAD. A clinically useful anatomic scoring system, if validated, may assist clinicians in risk stratification during the course of clinical decision making. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Heart Journal 05/2015; 170(2). DOI:10.1016/j.ahj.2015.04.026 · 4.46 Impact Factor
  • Jennifer Barrow · David J Magid · Jennifer Ellis · Susan Shetterly ·

    04/2015; 2(2):120-121. DOI:10.17294/2330-0698.1151

  • 04/2015; 2(2):99-100. DOI:10.17294/2330-0698.1103
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    Journal of the American Society of Hypertension 04/2015; 9(4):e47. DOI:10.1016/j.jash.2015.03.108 · 2.61 Impact Factor
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    ABSTRACT: Control of hypertension has improved nationally with focus on identifying and treating elevated blood pressures (BPs) to guideline recommended levels. However, once BP control is achieved, the frequency in which BP falls out of control and the factors associated with BP recidivism is unknown. In this retrospective cohort study conducted at 2 large, integrated health care systems we sought to examine rates and predictors of BP recidivism in adults with controlled hypertension. No change for methods, results and conclusion. Patients with a prior diagnosis of hypertension based on a combination of International Classification of Diseases, Ninth Revision, codes, receipt of antihypertensive medications, and/or elevated BP readings were eligible to be included. We defined controlled hypertension as normotensive BP readings (<140/90 mmHg or <130/80 mmHg in those with diabetes) at 2 consecutive primary care visits. We then followed up patients for BP recidivism defined by the date of the second of 2 consecutive BP readings >140/90 mmHg (>130/80 mmHg for diabetes or chronic kidney disease) during a median follow-up period of 16.6 months. Cox proportional hazards regression assessed the association between patient characteristics, comorbidities, medication adherence, and provider medication management with time to BP recidivism. A total of 23,321 patients with controlled hypertension were included in this study. The proportion of patients with hypertension recidivism was 24.1% over the 16.6-month study period. For those with BP recidivism, the median time to relapse was 7.3 months. In multivariate analysis, those with diabetes (hazard ratio [HR] 3.99, CI 3.67-4.33), high normal baseline BP (for systolic BP HR 1.03, CI 1.03-1.04), or low antihypertensive medication adherence (HR 1.20, CI 1.11-1.29) had significantly higher rates of hypertension recidivism. Limitations of this work include demographics of our patient sample, which may not reflect other communities in addition to the intrinsic limitations of office-based BP measurements. Hypertensive recidivism occurs in a significant portion of patients with previously well-controlled BP and accounts for a substantial fraction of patients with poorly controlled hypertension. Systematic identification of those most at risk for recidivism and implementation of strategies to minimize hypertension recidivism may improve overall levels of BP control and hypertension-related quality measures. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Heart Journal 03/2015; 169(6). DOI:10.1016/j.ahj.2015.03.012 · 4.46 Impact Factor

  • Journal of the American College of Cardiology 03/2015; 65(10):A1031. DOI:10.1016/S0735-1097(15)61031-2 · 16.50 Impact Factor
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    ABSTRACT: Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. The Breathe Well study was a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013. Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member. Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months. In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5% [1.2%] vs 35.5% [1.1%], respectively; P < .001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma. clinicaltrials.gov Identifier: NCT00958932.
    JAMA Pediatrics 02/2015; 169(4). DOI:10.1001/jamapediatrics.2014.3280 · 5.73 Impact Factor
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    ABSTRACT: Although paediatric growth charts are recommended for weight assessment prior to age 20, many teenagers transition earlier to adult care where absolute body mass index (BMI) is used. This study examines concordance of weight classification in older teenagers using paediatric percentiles and adult thresholds. BMI from 23 640 US teens ages 18-19 years were classified using paediatric BMI percentile criteria for underweight (< 5th), normal (5th to < 85th), overweight (85th to < 95th), obesity (≥ 95th) and severe obesity (≥ 120% × 95th percentile) and adult BMI (kg m(-2) ) criteria for underweight (< 18.5), normal (18.5-24.9), overweight (25-29.9) and obesity: class I (30-34.9), class II (35-39.9) and class III (≥ 40). Concordance was examined using the kappa (κ) statistic. Blood pressure (BP) from the same visit was classified hypertensive for BP ≥ 140/90. The majority of visits (72.8%) occurred in adult primary care. Using paediatric/adult criteria, 3.4%/5.2% were underweight, 66.6%/58.8% normal weight, 15.7%/21.7% overweight, 14.3%/14.3% obese and 4.9%/6.0% severely/class II-III obese, respectively. Paediatric and adult classification for underweight, normal, overweight and obesity were concordant for 90.3% (weighted κ 0.87 [95% confidence interval, 0.87-0.88]). For severe obesity, BMI ≥ 120% × 95th percentile showed high agreement with BMI ≥ 35 kg m(-2) (κ 0.89 [0.88-0.91]). Normal-weight males and moderately obese females by paediatric BMI percentile criteria who were discordantly classified into higher adult weight strata had a greater proportion with hypertensive BP compared with concordantly classified counterparts. Strong agreement exists between US paediatric BMI percentile and adult BMI classification for older teenagers. Adult BMI classification may optimize BMI tracking and risk stratification during transition from paediatric to adult care. © 2015 World Obesity.
    Pediatric Obesity 01/2015; 10(5). DOI:10.1111/ijpo.274 · 4.57 Impact Factor
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    ABSTRACT: An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction (HFpEF). We identified all adults with HFpEF between 2005 and 2008 from four health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. Among 13,437 adults with confirmed HFpEF, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR] 0.72, 95% CI: 0.62-0.85) and Asians (HR 0.75, 95% CI: 0.64-0.87) had lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR 1.48, 95% CI: 1.29-1.68); no difference was observed for Asians compared with whites (HR 1.01, 95% CI: 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR 1.03, 95% CI: 0.95-1.12) and for Asians (HR 0.93, 95% CI: 0.85-1.02). In a diverse population with HFpEF, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American Journal of Medicine 12/2014; 128(6). DOI:10.1016/j.amjmed.2014.11.034 · 5.00 Impact Factor
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    ABSTRACT: Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO. Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript. Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR. Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
    Annals of Emergency Medicine 12/2014; 65(5). DOI:10.1016/j.annemergmed.2014.10.028 · 4.68 Impact Factor
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    ABSTRACT: Importance Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD).Objective To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort.Design, Setting, and Participants Retrospective cohort study of all US veterans undergoing elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded.Exposures Angiographic CAD extent, defined by degree (no apparent CAD: no stenosis >20%; nonobstructive CAD: ≥1 stenosis ≥20% but no stenosis ≥70%; obstructive CAD: any stenosis ≥70% or left main [LM] stenosis ≥50%) and distribution (1, 2, or 3 vessel).Main Outcomes and Measures The primary outcome was 1-year hospitalization for nonfatal MI after the index angiography. Secondary outcomes included 1-year all-cause mortality and combined 1-year MI and mortality.Results Among 37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%-0.20%) and increased progressively by 1-vessel nonobstructive CAD, 0.24% (n = 10, 95% CI, 0.10%-0.40%); 2-vessel nonobstructive CAD, 0.56% (n = 13, 95% CI, 0.30%-1.00%); 3-vessel nonobstructive CAD, 0.59% (n = 6, 95% CI, 0.30%-1.30%); 1-vessel obstructive CAD, 1.18% (n = 101, 95% CI, 1.00%-1.40%); 2-vessel obstructive CAD, 2.18% (n = 110, 95% CI, 1.80%-2.60%); and 3-vessel or LM obstructive CAD, 2.47% (n = 137, 95% CI, 2.10%-2.90%). After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8-5.1); 2-vessel nonobstructive HR, 4.6 (95% CI, 2.0-10.5); 3-vessel nonobstructive HR, 4.5 (95% CI, 1.6-12.5); 1-vessel obstructive HR, 9.0 (95% CI, 4.2-19.0); 2-vessel obstructive HR, 16.5 (95% CI, 8.1-33.7); and 3-vessel or LM obstructive HR, 19.5 (95% CI, 9.9-38.2). One-year mortality rates were associated with increasing CAD extent, ranging from 1.38% among patients without apparent CAD to 4.30% with 3-vessel or LM obstructive CAD. After risk adjustment, there was no significant association between 1- or 2-vessel nonobstructive CAD and mortality, but there were significant associations with mortality for 3-vessel nonobstructive CAD (HR, 1.6; 95% CI, 1.1-2.5), 1-vessel obstructive CAD (HR, 1.9; 95% CI, 1.4-2.6), 2-vessel obstructive CAD (HR, 2.8; 95% CI, 2.1-3.7), and 3-vessel or LM obstructive CAD (HR, 3.4; 95% CI, 2.6-4.4). Similar associations were noted with the combined outcome.Conclusions and Relevance In this cohort of patients undergoing elective coronary angiography, nonobstructive CAD, compared with no apparent CAD, was associated with a significantly greater 1-year risk of MI and all-cause mortality. These findings suggest clinical importance of nonobstructive CAD and warrant further investigation of interventions to improve outcomes among these patients.
    JAMA The Journal of the American Medical Association 11/2014; 312(17):1754-63. DOI:10.1001/jama.2014.14681 · 35.29 Impact Factor
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    ABSTRACT: Background: Prior research has shown that high- risk census tracts for out-of-hospital cardiac arrest (OHCA) can be identified. High-risk neighborhoods are defined as having a high incidence of OHCA and a low prevalence of bystander cardiopulmonary resuscitation (CPR). However, there is no consensus regarding the process for identifying high-risk neighborhoods. Objective: We propose a novel summary approach to identify high-risk neighborhoods through three separate spatial analysis methods: Empirical Bayes (EB), Local Moran's I (LISA), and Getis Ord Gi* (Gi*) in Denver, Colorado. Methods: We conducted a secondary analysis of prospectively collected Emergency Medical Services data of OHCA from January 1, 2009 to December 31, 2011 from the City and County of Denver, Colorado. OHCA incidents were restricted to those of cardiac etiology in adults >= 18 years. The OHCA incident locations were geocoded using Centrus. EB smoothed incidence rates were calculated for OHCA using Geoda and LISA and Gi* calculated using ArcGIS 10. Results: A total of 1102 arrests in 142 census tracts occurred during the study period, with 887 arrests included in the final sample. Maps of clusters of high OHCA incidence were overlaid with maps identifying census tracts in the below the Denver County mean for bystander CPR prevalence. Five census tracts identified were designated as Tier 1 high-risk tracts, while an additional 7 census tracts where designated as Tier 2 high-risk tracts. Conclusion: This is the first study to use these three spatial cluster analysis methods for the detection of high-risk census tracts. These census tracts are possible sites for targeted community-based interventions to improve both cardiovascular health education and CPR training.
    Resuscitation 09/2014; 85(12). DOI:10.1016/j.resuscitation.2014.08.029 · 4.17 Impact Factor
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    ABSTRACT: Purpose To assess the impact of personalised physician learning (PPL) interventions using simulated learning cases on control of hypertension and dyslipidaemia in primary care settings. Methods A total of 132 primary care physicians, 4568 eligible patients with uncontrolled hypertension, and 15 392 eligible patients with uncontrolled dyslipidaemia were cluster-randomised to one of three conditions: (a) no intervention, (b) PPL-electronic medical record (EMR) intervention in which 12 PPL cases were assigned to each physician based on observed patterns of care in the EMR in the previous year, or (c) PPL-ASSESS intervention in which 12 PPL cases were assigned to each physician based on their performance on four standardised assessment cases. General and generalised linear mixed models were used to account for clustering and to model differences in patient outcomes in the study arms. Results Among patients with uncontrolled hypertension at baseline, 49.1%, 46.6% and 47.3% (p=0.43) achieved blood pressure (BP) targets at follow-up. Among patients with uncontrolled dyslipidaemia at baseline, 37.5%, 37.3% and 38.1% (p=0.72) achieved low density lipoprotein cholesterol targets at follow-up in PPL-EMR, PPL-ASSESS and the control group, respectively. Although systolic (BP) (p<0.001) and lipid (p<0.001) values significantly improved during the study, the group-by-time interaction term showed no differential change in systolic BP values (p=0.51) or lipid values (p=0.61) among the three study arms. No difference in intervention effect was noted when comparing the PPL-EMR with the PPL-ASSESS intervention (p=0.47). Conclusions The two PPL interventions tested in this study did not lead to improved control of hypertension or dyslipidaemia in primary care clinics during a mean 14-month follow-up period. This null result may have been due in part to substantial overall improvement in BP and lipid control at the study sites during the study. Trial registration number NCT00903071.
    BMJ quality & safety 09/2014; 23(12). DOI:10.1136/bmjqs-2014-002807 · 3.99 Impact Factor

Publication Stats

12k Citations
2,117.45 Total Impact Points


  • 2004-2015
    • Kaiser Permanente
      • • Center for Health Research (Oregon, Hawaii, and Georgia)
      • • Department of Pharmacy
      Oakland, California, United States
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 2001-2015
    • University of Colorado
      • • Department of Emergency Medicine
      • • Department of Medicine
      Denver, Colorado, United States
    • University of Missouri - Kansas City
      Kansas City, Missouri, United States
  • 2013
    • HealthPartners Institute for Education and Research
      블루밍턴, Minnesota, United States
  • 2012
    • University of Colorado Hospital
      Denver, Colorado, United States
  • 2003-2012
    • Emory University
      • Department of Emergency Medicine
      Atlanta, Georgia, United States
  • 2009
    • The University of Arizona
      • College of Pharmacy
      Tucson, Arizona, United States
  • 1997-2008
    • Permanente Medical Group
      Pasadena, California, United States
  • 2007
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2005-2007
    • Regions Hospital
      Saint Paul, Minnesota, United States
    • Imperial College London
      Londinium, England, United Kingdom
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2006
    • University of Rochester
      Rochester, New York, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005-2006
    • Yale University
      • Department of Internal Medicine
      New Haven, Connecticut, United States
  • 2002
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States