Harlan R Sayles

Publications (2)0 Total impact

• Article: Gout-related healthcare utilization in U.S. emergency departments, 2006 through 2008.

  Rohini Garg, Harlan R Sayles, Fang Yu, Kaleb Michaud, Jasvinder Singh, Kenneth G Saag, Ted R Mikuls
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  ABSTRACT: OBJECTIVE: To characterize gout-related emergency department (ED) utilization using a nationally representative sample and to examine factors associated with the frequency and charges of gout-related ED visits. METHODS: Using the National Emergency Department Sample (NEDS) data from 2006 to 2008, the weighted national frequency of gout visits was calculated along with median ED charge and total national ED-related charges. Associations of several patient- and facility-level factors were examined with the occurrence of gout visits using multivariable logistic regression and with ED-related charges using multivariable linear regression. RESULTS: Gout was the primary indication for 168,410 ED visits in 2006, 171,743 visits in 2007, and 174,823 visits in 2008, accounting for ∼0.2% of all visits annually and generating ED charges of more than $128 million in 2006, $ 144 million in 2007, and $166 million in 2008. Age, male gender, household income less than $38,000, private insurance and Medicaid status are associated with an increased propensity for ED utilization in gout. Higher ED-related charges for gout were associated with female gender, age, a higher number of coded diagnoses, and a metropolitan residence. CONCLUSION: Gout accounts for a substantial proportion of ED visits leading to significant healthcare charges. Effective strategies to reduce gout burden in EDs could potentially benefit by targeting groups characterized by factors demonstrated to be related to a higher ED utilization in gout as identified by our study.
  Arthritis care & research. 09/2012;
• Article: A prospective study of posttraumatic stress disorder (PTSD) and disease activity outcomes in U.S. veterans with Rheumatoid Arthritis.

  Ted R Mikuls, Prasad R Padala, Harlan R Sayles, Fang Yu, Kaleb Michaud, Liron Caplan, Gail S Kerr, Andreas Reimold, Grant W Cannon, J Steuart Richards, Deana Lazaro, Geoffrey M Thiele, Joseph A Boscarino
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  ABSTRACT: OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in U.S. veterans with rheumatoid arthritis (RA). METHODS: U.S. veterans with RA were enrolled in a longitudinal observational study and were categorized as having 1) PTSD, 2) other anxiety/depression disorders, or 3) neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed effects models were used to examine the associations of diagnostic groups with outcomes measured over a mean follow-up period of 3.0 years. RESULTS: At enrollment, 1,522 patients had a mean age of 63 years, were primarily men (91%), and a majority (78%) reported Caucasian race. A diagnosis of PTSD was observed in 178 (11.7%) and other anxiety/depression diagnoses (excluding PTSD) were found in 360 (23.7%) patients. Presence of a PTSD diagnosis was independently associated with higher values of self-reported pain, physical impairment, tender joint count, and worse patient global well-being scores compared to patients with no psychiatric diagnosis. There were no significant group differences in swollen joint count, erythrocyte sedimentation rate (ESR), or Disease Activity Score (DAS)-28. There were no differences for any outcomes comparing those with PTSD and those with other anxiety/depression diagnoses. CONCLUSION: In this RA cohort, the diagnosis of PTSD was associated with worse patient-reported outcomes and tender joint counts but not with other physician- or laboratory-based measures of disease activity. These results suggest that PTSD, along with other anxiety / depression disorders, may confound RA disease activity assessments that rely on patient-reported outcomes and resulting treatment decisions. © 2012 by the American College of Rheumatology.
  Arthritis care & research. 06/2012;