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Evaluation of an intervention targeted with predictive analytics to prevent readmissions in an integrated health system: observational study

To determine the associations between a care coordination intervention (the Transitions Program) targeted to patients after hospital discharge and 30 day readmission and mortality in a large, integrated healthcare system. Observational study. 21 hospitals operated by Kaiser Permanente Northern California.…

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Hospital Alternatives (HALT)

The SRI team will (a) assess results of previous internal and external deployments of alternatives to hospitalization, (b) define strategies to quantify the potential pool of Kaiser Permanente Northern California patients who would be eligible for such alternatives, (c) develop…

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Comparison of Early Warning Scoring Systems for Hospitalized Patients With and Without Infection at Risk for In-Hospital Mortality and Transfer to the Intensive Care Unit

Risk scores used in early warning systems exist for general inpatients and patients with suspected infection outside the intensive care unit (ICU), but their relative performance is incompletely characterized. To compare the performance of tools used to determine points-based risk…

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Association Between Peripheral Blood Oxygen Saturation (SpO2)/Fraction of Inspired Oxygen (FiO2) Ratio Time at Risk and Hospital Mortality in Mechanically Ventilated Patients

Acute respiratory failure requiring mechanical ventilation is a leading cause of mortality in the intensive care unit. Although single peripheral blood oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) ratios of hypoxemia have been evaluated to risk-stratify patients with acute respiratory distress…

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Does Information about Members’ Social Determinants of Health Improve Prediction of Risk for Hospitalization, Emergency Department Visits, and Outpatient Utilization?

The new Kaiser Permanente Your Current Life Situation (YCLS) screening questionnaire will be mailed to a random sample of 7,000 adult members of Kaiser Permanente Northern California (KPNC), oversampling patients at low to medium risk for hospitalization. After receiving responses,…

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Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery

Determining the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes for postpartum hemorrhage (PPH) is vital for reaching valid conclusions about the epidemiology of PPH. Our primary objectives were to assess the performance characteristics of ICD-9…

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Incorporating Longitudinal Comorbidity and Acute Physiology Data in Template Matching for Assessing Hospital Quality: An Exploratory Study in an Integrated Health Care Delivery System

We sought to build on the template-matching methodology by incorporating longitudinal comorbidities and acute physiology to audit hospital quality. Patients admitted for sepsis and pneumonia, congestive heart failure, hip fracture, and cancer between January 2010 and November 2011 at 18…

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Prediction of Recurrent Clostridium Difficile Infection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

BACKGROUND Predicting recurrent Clostridium difficile infection (rCDI) remains difficult. We employed a retrospective cohort design. Granular electronic medical record (EMR) data had been collected from patients hospitalized at 21 Kaiser Permanente Northern California hospitals. The derivation dataset (2007-2013) included data…

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Advance Alert Monitor Operations

The Systems Research Initiative will provide project management and operational consultation for the spread of the Advance Alert Monitor within KPNC between 10/1/16 and 9/30/18. During this time Division of Research will complete the following tasks: continue the support of…

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Early detection of critical illness outside the intensive care unit: Clarifying treatment plans and honoring goals of care using a supportive care team

Given the high mortality experienced by patients who deteriorate outside the intensive care unit, issues related to patient preferences around escalation of care are common. However, the literature on early warning systems (EWSs) provides limited information on how respecting patient…

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Evaluation Following Staggered Implementation of the “Rethinking Critical Care” ICU Care Bundle in a Multicenter Community Setting

To evaluate process metrics and outcomes after implementation of the "Rethinking Critical Care" ICU care bundle in a community setting. Retrospective interrupted time-series analysis. Three hospitals in the Kaiser Permanente Northern California integrated healthcare delivery system. ICU patients admitted between…

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Lack of improved outcomes with increased use of targeted temperature management following out-of-hospital cardiac arrest: A multicenter retrospective cohort study

To assess whether increased use of targeted temperature management (TTM) within an integrated healthcare delivery system resulted in improved rates of good neurologic outcome at hospital discharge (Cerebral Performance Category score of 1 or 2). Retrospective cohort study of patients…

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An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines

Adherence to evidence-based recommendations for acute myocardial infarction (AMI) remains unsatisfactory. Quantifying association between using an electronic AMI order set (AMI-OS) and hospital processes and outcomes. Retrospective cohort study. Twenty-one community hospitals. A total of 5879 AMI patients were hospitalized…

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Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations

Immunoprophylaxis is the only pharmaceutical intervention for mitigating respiratory syncytial virus (RSV) infection. Patient level data on adherence to American Academy of Pediatrics (AAP) immunoprophylaxis recommendations are limited. This study characterizes adherence to AAP guidelines in privately insured and Medicaid…

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Persistent recurring wheezing in the fifth year of life after laboratory-confirmed, medically attended respiratory syncytial virus infection in infancy

Respiratory syncytial virus (RSV) infection in infancy is associated with subsequent recurrent wheezing. A retrospective cohort study examined children born at ?32 weeks gestation between 1996-2004. All children were enrolled in an integrated health care delivery system in Northern California…

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Risk-adjusting Hospital Mortality Using a Comprehensive Electronic Record in an Integrated Health Care Delivery System

OBJECTIVE: Using a comprehensive inpatient electronic medical record, we sought to develop a risk-adjustment methodology applicable to all hospitalized patients. Further, we assessed the impact of specific data elements on model discrimination, explanatory power, calibration, integrated discrimination improvement, net reclassification…

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Frequency, duration and predictors of bronchiolitis episodes of care among infants [greater than or equal to]32 weeks gestation in a large integrated healthcare system: a retrospective cohort study

BACKGROUND: Bronchiolitis is common in the first two years of life and is the most frequent cause of hospitalization in this age group. No previous studies have used an episode-of-care analysis to describe the frequency, duration, and predictors of bronchiolitis…

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Early detection of impending physiologic deterioration among patients who are not in intensive care: Development of predictive models using data from an automated electronic medical record

BACKGROUND: Ward patients who experience unplanned transfer to intensive care units have excess morbidity and mortality. OBJECTIVE: To develop a predictive model for prediction of unplanned transfer from the medical-surgical ward to intensive care (or death on the ward in…

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Respiratory syncytial virus testing during bronchiolitis episodes of care in an integrated health care delivery system: a retrospective cohort study

BACKGROUND: Bronchiolitis has the highest incidence rate of any lower respiratory infection among infants and children /=41 weeks' GA. Bronchiolitis hospitalization, younger chronologic age, prematurity, and RSV season were associated with RSV testing in a multivariate model controlling for other…

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Recurrent wheezing in the third year of life among children born at 32 weeks’ gestation or later: relationship to laboratory-confirmed, medically attended infection with respiratory syncytial virus during the first year of life

OBJECTIVE: To quantify the relationship between recurrent wheezing (RW) in the third year of life and respiratory syncytial virus (RSV) infection, prematurity, and neonatal oxygen exposure. DESIGN: Retrospective cohort study linking inpatient, outpatient, and laboratory databases for cohort assembly and…

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Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia

AIMS/HYPOTHESIS: Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than those of…

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Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom

OBJECTIVE: To compare gestational age at discharge between infants born at 30-34(+6) weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom. DESIGN: Prospective observational cohort study. SETTING: Fifty four United…

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Looking for Trouble in All the Right Places: The Legal Implications Associated with ‘Electronic Signatures’ and High-risk Clinical Situations

Background: Voluntary reporting systems identify only a fraction of medical errors. Electronic identification mechanisms, which are more efficient, have been defined for adverse drug events. However, similar systems are lacking for other types of errors. Objective: The investigators sought to…

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Preventing neonatal group B streptococcal disease: cost-effectiveness in a health maintenance organization and the impact of delayed hospital discharge for newborns who received intrapartum antibiotics

OBJECTIVES: To estimate the cost and health benefits of implementing a risk factor-based prevention strategy for early-onset neonatal group B streptococcal (GBS) disease, using baseline assumptions and costs from a health maintenance organization. With the risk factor-based strategy, intrapartum antibiotics…

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