Vani Nimbal

• Palo Alto Medical Foundation

Background: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. Objective: We sought to evaluate determinants of generic prescribing of levothyroxine. Methods: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with...

Background: Generic drug use in the outpatient setting is typically measured with adjudicated pharmacy claims; however, not all delivery systems have access to these data for their clinical populations. Objective: To develop an algorithm to estimate generic drug use in an outpatient setting using electronic health records (EHR) data. Methods:...

Background/Aims: While 86% of all drugs in the United States are dispensed as generics, this rate is not uniform across all therapeutic classes and drug products. The role of the health care provider in influencing generic use is not well understood. We sought to quantify variation between providers and provider-specific determinants of generic pre...

Background/Aims: Patient-provider race/ethnicity or language (REL) concordance can influence quality of communication and thus patient experiences of care. We explored this relationship among the largest and fastest growing immigrant populations in the United States –– Asian Indian, Chinese and Latinos –– compared to non-Hispanic whites (NHW). Meth...

Objective The objective of this study is to examine whether a first trimester hemoglobin A1c (A1C) of 5.7 to 6.4% predicts an abnormal second trimester oral glucose tolerance test (OGTT). Methods We conducted a retrospective cohort study of all women screened with A1C through 13 6/7 weeks' gestation between January 1, 2011, and December 31, 2012. P...

This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortal...

Background: We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care. Methods: This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of...

Background: The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the need to disaggregate Asian American subgroups to better understand this heterogeneous racial group. This study aims to assess racial/ethnic differences in r...

This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortal...

Background/Aims: This study aims to identify racial/ethnic differences in the relationship between body mass index (BMI) and insulin resistance across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexicans, non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in a large, mixed-payer ambulatory care s...

Background: This study assesses racial/ethnic differences in CVD outcomes among patients with hypertension (HTN) or type 2 diabetes (T2DM) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexican, non-Hispanic black (NHB), and non-Hispanic White (NHW) in a large, mixed payer ambulatory care setting in...

Aim: The purpose of this study was to evaluate the effectiveness of early versus delayed initiation of metformin in type 2 diabetes. Methods: We identified 2925 new users of metformin with type 2 diabetes between 2005 and 2012 in the electronic health records of an integrated health system in Northern California. Patients were matched 1:1 on the...

Background: Higher rates of CVD have been found in Mexicans and some Asian American subgroups as well as African Americans. However, little is known about the association between HTN, a main risk factor of CVD, and CVD among rapidly growing minority groups. Our study aims to identify racial/ethnic differences in CVD outcomes in HTN patients across...

Background: Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed t...

In patients with diabetes mellitus (DM) in the general population, elevated glycosylated hemoglobin (HbA(1c)) increases the risk for developing heart failure (HF). However, in patients with established HF, the association of HbA(1c) level with outcomes is not well established. The aim of this study was to investigate the relation between HbA(1c) an...