Fohner, Alison
Electronic Health Record-Based Dementia Prediction for HIV Primary Care
The goal of this K01 Career Development Award is to receive mentored training on the development of risk prediction models for dementia in people with HIV using electronic health records data. The project will quantify the contribution of HIV- and…
Long-term effectiveness of BPH/LUTS pharmacological therapies and using machine learning based predictive analytics to tailor treatment.
This career development award project will compare the effectiveness of pharmacological therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia in preventing long-term disease progression; and develop and validate predictive models using demographic, clinical, and laboratory data available…
Validation of Natural Language Processing to Determine the Presence and Size of Abdominal Aortic Aneurysms in a Large Integrated Health System
Previous studies of the natural history of abdominal aortic aneurysms (AAAs) have been limited by small cohort sizes or heterogeneous analyses of pooled data. By quickly and efficiently extracting imaging data from the health records, natural language processing (NLP) has…
Using predictive analytics to tailor care for patients with newly diagnosed type 2 diabetes
In a population of adults newly diagnosed with type 2 diabetes (T2D) from 2010-2015 and followed for 5 years this study will use machine learning-based predictive analytic methods to develop and validate predictive models using EHR-derived patient data available at…
Nonstationary Multivariate Gaussian Processes for Electronic Health Records
Advances in the modeling and analysis of electronic health records (EHR) have the potential to improve patient risk stratification, leading to better patient outcomes. The modeling of complex temporal relations across the multiple clinical variables inherent in EHR data is…
Investigating Bias from Missing Data in an Electronic Health Records-Based Study of Weight Loss After Bariatric Surgery
Missing data is common in electronic health records (EHR)-based obesity research. To avoid bias, it is critical to understand mechanisms that underpin missingness. We conducted a survey among bariatric surgery patients in three integrated health systems to (i) investigate predictors…
Building an Evidence Case for Capturing Educational Attainment in the EHR as a Social Determinant of Health
Educational attainment is an important social determinant of health, but it is not included in the electronic health records of a majority of adults. When the information is available, it is frequently not captured in a way that makes it…
The Use of Natural Language Processing to Characterize Episodes of Outpatient Worsening Heart Failure within an Integrated Health Care Delivery System
This study will assess the accuracy of using a natural language processing-based approach to retrospectively identify episodes of outpatient worsening heart failure in unstructured electronic health record data within an integrated health care delivery system and assess the burden and…
PREDICTION OF OBSTETRIC AND FETAL COMPLICATIONS USING AUTOMATED ELECTRONIC HEALTH RECORD DATA
An increasing number of delivering women experience major morbidity and mortality. Limited work has been done on automated predictive models that could be used for prevention. Using only routinely collected obstetrical data, this study aimed to develop a predictive model…
An Electronic Health Record-Based Tool to Identify Newly Diagnosed Breast Cancer Patients at Risk of Low Social Support
Goals of the project are to: 1) Identify terms from content in the EHR, based on theory and prior literature, and informed by clinical stakeholders in BC care, that measure structural and/or functional social support, have been associated with BC…
Inpatient-outpatient shared electronic health records: telemedicine and laboratory follow-up after hospital discharge
Continuity of patient information across settings can improve transitions after hospital discharge, but outpatient clinicians often have limited access to complete information from recent hospitalizations. We examined whether providers' timely access to clinical information through shared inpatient-outpatient electronic health records…
Assessment of Value of Neighborhood Socioeconomic Status in Models That Use Electronic Health Record Data to Predict Health Care Use Rates and Mortality
Prediction models are widely used in health care as a way of risk stratifying populations for targeted intervention. Most risk stratification has been done using a small number of predictors from insurance claims. However, the utility of diverse nonclinical predictors,…
A Comparative Analysis of Online Medical Record Utilization and Perception by Cancer Survivorship
Cancer survivors face many challenges including coordinating care across multiple providers and maintaining medical records from multiple institutions. Access and utilization of online medical records could help cancer survivors manage this complexity. Here, we examined how cancer survivors differ from…
Innovative Methods to Inform Estimates of Vaccine Effectiveness Using Information on the Epidemiology and Incidence of Influenza and Other Acute Respiratory Illnesses
This study will estimate influenza vaccine effectiveness by vaccine type and for different ages by combining data from medical records, vaccine registries, and results of clinician-ordered molecular tests for influenza virus infection at Kaiser Permanente Northern California.
The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation
Electronic health record (EHR)-based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use…
Extended Window for Thrombectomy – Have we extended our resources appropriately and effectively
Study will evaluate the performance of the RAPID software interpretation of CT perfusion (CTP) studies and determination of qualifications for endovascular therapy (EST). It will include a retrospective case review of prospectively collected data on consecutive stroke patients seen during…
Sepsis on FHIR
Overall goal is to define and refine the current epidemiology, clinical characteristics, and treatment practices in respiratory failure in late and moderately preterm infants. Specific aims are to determine that incidence and epidemiology of respiratory failure in neonates born 32-36…
A Scalable Database of Organ Doses for Common Diagnostic Fluoroscopy Procedures of Children: Procedures of Historical Practice for Use in Radiation Epidemiology Studies
Assessment of health effects from low-dose radiation exposures in patients undergoing diagnostic imaging is an active area of research. High-quality dosimetry information pertaining to these medical exposures is generally not readily available to clinicians or epidemiologists studying radiation-related health risks.…
Care System Analytics to Support Primary Care Patients with Complex Medical and Social Needs
This study will leverage the rich electronic data sources within Kaiser Permanente to create pragmatic tools for improving health and equity among primary care patients with the highest medical and social needs. Aim 1: Use advanced analytic methods to predict…
Community-based, Longitudinal Cohort of Patients with Interstitial Lung Disease (ILD) in the Kaiser Permanente Northern California (KPNC) Health System
The KPNC-ILD cohort will consist of approximately 10,000 patients with interstitial lung disease. It will be built through electronic health recordbased case identification using an algorithm that will be further developed. We anticipate optimizing the existing KPNC-ILD algorithm and having…
Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016
Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. To evaluate recent trends in medical imaging. Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to…
Do no harm: a roadmap for responsible machine learning for health care
Interest in machine-learning applications within medicine has been growing, but few studies have progressed to deployment in patient care. We present a framework, context and ultimately guidelines for accelerating the translation of machine-learning-based interventions in health care. To be successful,…
Community-Based, Longitudinal cohort of Patients with Interstitial Lung Disease in the Kaiser Permanente Northern California Health System
The study aim is to optimize the Kaiser Permanente Northern California (KPNC) Interstitial Lung Disease (ILD) algorithm and establish the KPNC-ILD cohort. The KPNC-ILD cohort will consist of approximately 10,000 patients with ILD. It will be built through electronic health…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity, and Patient Outcomes
Using a theory-driven conceptual framework, this multimethod study examines factors that facilitate or impede the successful implementation and long-term sustainability of screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use in real-world health care settings. This study…
Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016
The use of medical imaging has sharply increased over the last 2 decades. Imaging rates during pregnancy have not been quantified in a large, multisite study setting. To evaluate patterns of medical imaging during pregnancy. A retrospective cohort study was…
Evaluation of Complex Interventions on Drug (Re)Fill Behavior Using Electronic Health Care Data
This study develops generalized per-protocol analyses based on Inverse Probability Weighting and Targeted Learning to control for or evaluate the effect of medication nonadherence in observational studies that use electronic health databases to inform the management of chronic conditions. Unlike…
Privacy-Protecting Analytical Methods Using Only Aggregate-Level Information to Conduct Multivariable-Adjusted Analysis in Distributed Data Networks
Distributed data networks enable large-scale epidemiologic studies, but protecting privacy while adequately adjusting for a large number of covariates continues to pose methodological challenges. Using 2 empirical examples within a 3-site distributed data network, we tested combinations of 3 aggregate-level…
Using EHR Audit Logs to Capture Diagnostic Pathways and Time to Diagnosis
Rapid expansions in the use of electronic health record (EHR) systems also contribute to large expansions in the availability of metadata. These highly granular metadata may prove particularly useful for understanding how frontline clinicians interact with clinical information when making…
System-Level Capture of Family History Data to Assess Risk of Cancer and Provide Longitudinal Care Coordination
Genetic risk and family history, which includes personal medical history, increasingly influence medical care, but optimal methods for capturing the hereditary risk of disease and the outcomes of such assessments are unknown. Using inherited cancer as a model, this study…
Patterns of Health Care Utilization Before First Episode Psychosis in Racial and Ethnic Groups
To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients. The study was a retrospective observational design. The study was conducted in five health care systems in the western…
Using natural language processing and machine learning to classify health literacy from secure messages: The ECLIPPSE study
Limited health literacy is a barrier to optimal healthcare delivery and outcomes. Current measures requiring patients to self-report limitations are time-consuming and may be considered intrusive by some. This makes widespread classification of patient health literacy challenging. The objective of…
Inpatient electronic health record maintenance from 2010 to 2015
To describe the scale and scope of inpatient electronic health record (EHR) maintenance following initial implementation. A retrospective study reviewing EHR change documentation within an integrated healthcare delivery system that has 21 hospitals. Between 2010 and 2015, we identified and categorized…
The health information technology special issue: new real-world evidence and practical lessons
As technology applications in healthcare continue to grow, electronic health records are maturing, interoperability is developing, and patient-facing technology use is expanding.
Accurate Identification of Colonoscopy Quality and Polyp Findings Using Natural Language Processing
The aim of this study was to test the ability of a commercially available natural language processing (NLP) tool to accurately extract examination quality-related and large polyp information from colonoscopy reports with varying report formats. Colonoscopy quality reporting often requires…
Characterization of Statin Low-Density Lipoprotein Cholesterol Dose-Response Using Electronic Health Records in a Large Population-Based Cohort
Low-density lipoprotein cholesterol (LDL-C) response to statin therapy has not been fully elucidated in real-world populations. The primary objective of this study was to characterize statin LDL-C dose-response and its heritability in a large, multiethnic population of statin users. We…
Alcohol, Marijuana, and Opioid Use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters
Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a…
Lessons learned in acute heart failure.
Acute heart failure (HF) is a global pandemic with more than one million admissions to hospital annually in the US and millions more worldwide. Post-discharge mortality and readmission rates remain unchanged and unacceptably high. Although recent drug development programmes have…
Identifying Distinct Subgroups of ICU Patients: A Machine Learning Approach
Identifying subgroups of ICU patients with similar clinical needs and trajectories may provide a framework for more efficient ICU care through the design of care platforms tailored around patients' shared needs. However, objective methods for identifying these ICU patient subgroups…
Serious mental illness and medical comorbidities: Findings from an integrated health care system
To examine the odds associated with having medical comorbidities among patients with serious mental illness (SMI) in a large integrated health system. In a secondary analysis of electronic health record data, this study identified 25,090 patients with an ICD-9 SMI…
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…
Adaptation of the Acute Organ Failure Score for Use in a Medicare Population
Without widely available physiologic data, a need exists for ICU risk adjustment methods that can be applied to administrative data. We sought to expand the generalizability of the Acute Organ Failure Score by adapting it to a commonly used administrative…
Heterogeneity in national U.S. mortality trends within heart disease subgroups, 2000-2015
The long-term downward national U.S. trend in heart disease-related mortality slowed substantially during 2011-2014 before turning upward in 2015. Examining mortality trends in the major subgroups of heart disease may provide insight into potentially more targeted and effective prevention and…
Piloting electronic medical record-based early detection of inpatient deterioration in community hospitals
Patients who deteriorate in the hospital outside the intensive care unit (ICU) have higher mortality and morbidity than those admitted directly to the ICU. As more hospitals deploy comprehensive inpatient electronic medical records (EMRs), attempts to support rapid response teams…
In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis
We sought to investigate whether treatment of subnormal (
Developing a framework for implementing intensive care unit diaries: a focused review of the literature
Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies. We…
Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. To develop a new definition and clinical criteria for identifying septic shock…
Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown. To evaluate the validity of clinical criteria to…
User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits
Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Our aim was to employ a user-centered design process…
Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine
Studies suggest that dexmedetomidine-an intravenous central-acting ?2-adrenergic agonist that effectively reduces anxiety among critically ill patients-is being used in patients with severe alcohol withdrawal. However, evidence supporting its use is limited, and it is not approved for this indication. To…
Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges
The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent…
Variation in the Contents of Sepsis Bundles and Quality Measures: A Systematic Review
Sepsis contributes to one in every two to three inpatient hospital deaths. Early recognition and treatment are instrumental in reducing mortality, yet there are substantial quality gaps. Sepsis bundles containing quality metrics are often used in efforts to improve outcomes.…
Nonelective Rehospitalizations and Postdischarge Mortality: Predictive Models Suitable for Use in Real Time
Hospital discharge planning has been hampered by the lack of predictive models. To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). Retrospective cohort study using split validation. Integrated health…
Comparing US paediatric and adult weight classification at the transition from late teenage to young adulthood
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…
International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF): rationale for and design of a global registry.
AIMS: The clinical characteristics, initial presentation, management, and outcomes of patients hospitalized with new-onset (first diagnosis) heart failure (HF) or decompensation of chronic HF are poorly understood worldwide. REPORT-HF (International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment…
Preliminary Development and Evaluation of an Algorithm to Identify Breast Cancer Chemotherapy Toxicities Using Electronic Medical Records and Administrative Data
Breast cancer chemotherapy toxicity is not well documented outside of randomized trials. We developed and conducted preliminary evaluation of an algorithm to detect grade 3 and 4 toxicities using electronic data from a large integrated managed care organization. The algorithm…
Big Data, Miniregistries: A Rapid-Turnaround Solution to Get Quality Improvement Data into the Hands of Medical Specialists
The cost to build and to maintain traditional registries for many dire, complex, low-frequency conditions is prohibitive. The authors used accessible technology to develop a platform that would generate miniregistries (small, routinely updated datasets) for surveillance, to identify patients who…
Trends in Elective Labor Induction for Six United States Health Plans, 2001-2007
To describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. This retrospective cohort study included 339,123…
Accuracy of hospital standardized mortality rates: effects of model calibration
Risk-adjusted mortality rates are commonly used in quality report cards to compare hospital performance. The risk adjustment depends on models that are assessed for goodness-of-fit using various discrimination and calibration measures. However, the relationship between model fit and the accuracy…
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…
Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity
Randomized controlled trial evidence supports a restrictive strategy of red blood cell (RBC) transfusion, but significant variation in clinical transfusion practice persists. Patient characteristics other than hemoglobin levels may influence the decision to transfuse RBCs and explain some of this…
Validity of diagnostic codes and prevalence of psoriasis and psoriatic arthritis in a managed care population, 1996-2009
Few population-based studies have reported the prevalence of psoriatic disease. We validated computerized diagnoses to estimate the prevalence of psoriasis and psoriatic arthritis. We identified adults with ?1 ICD-9 diagnosis codes of 696.0 (psoriatic arthritis) or 696.1 (psoriasis) in clinical…
Visitation policies and practices in United States intensive care units
Prior reports suggest that restrictive ICU visitation policies can negatively impact patients and their loved ones. However, visitation practices in US ICUs, and the hospital factors associated with them, are not well described. A telephone survey was made of ICUs,…
Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant candidates: methods, feasibility and initial experience.
AIMS: In patients undergoing orthotopic liver transplantation (OLT), coronary artery disease (CAD), obstructive and nonobstructive, is associated with high morbidity and mortality. In OLT candidates, stress testing for detecting ischemia is often inaccurate, and this patient population often has relative…
HIV quality performance measures in a large integrated health care system
HIV quality performance measurements are critical to evaluating a care program's success in areas of testing, access to and retention in care, care processes and outcomes. Kaiser Permanente (KP) provides care to over 8 million Americans and over 19,000 HIV-infected…
Length of stay predictions: improvements through the use of automated laboratory and comorbidity variables
BACKGROUND: Length of stay (LOS) is a common measure of hospital resource utilization. Most methods for risk-adjusting LOS are limited by the use of only administrative data. Recent studies suggest that adding automated clinical data to these models improves performance.…
Effect of choice of estimation method on inter-hospital mortality rate comparisons
OBJECTIVE: To evaluate and compare the use of 6 different methods for calculating expected mortality rates and standardized mortality ratios (SMRs) when performing interhospital mortality rate comparisons. DESIGN: Retrospective cohort study using actual and simulated hospitalization data to evaluate the…
The Kaiser Permanente inpatient risk adjustment methodology was valid in an external patient population
OBJECTIVES: Accurately predicting hospital mortality is necessary to measure and compare patient care. External validation of predictive models is required to truly prove their utility. This study assessed the Kaiser Permanente inpatient risk adjustment methodology for hospital mortality in a…
Increased risk of adverse neurological development for late preterm infants
OBJECTIVE: To assess the risks of moderate prematurity for cerebral palsy (CP), developmental delay/mental retardation (DD/MR), and seizure disorders in early childhood. STUDY DESIGN: Retrospective cohort study using hospitalization and outpatient databases from the Northern California Kaiser Permanente Medical Care…
Risk factors for severe hyperbilirubinemia among infants with borderline bilirubin levels: a nested case-control study
OBJECTIVE: To estimate the effect of phototherapy and other predictors on the risk of total serum bilirubin (TSB) >or= 25 mg/dL in infants with a TSB of 17 to 22.9 mg/dL at age >or= 48 hours. STUDY DESIGN: From a…
Risk-adjusting hospital inpatient mortality using automated inpatient, outpatient, and laboratory databases
OBJECTIVES: To develop a risk-adjustment methodology that maximizes the use of automated physiology and diagnosis data from the time period preceding hospitalization. DESIGN: : Retrospective cohort study using split-validation and logistic regression. SETTING: Seventeen hospitals in a large integrated health…
Risk adjusting community-acquired pneumonia hospital outcomes using automated databases
OBJECTIVE: To describe the development and assessment of the Abbreviated Fine Severity Score (AFSS), a simplified version of the Pneumonia Severity Index (PSI) suitable for providing risk-adjusted reports to clinicians caring for patients hospitalized with community-acquired pneumonia. STUDY DESIGN: Retrospective…
Racial differences in the use of respiratory medications in premature infants after discharge from the neonatal intensive care unit
OBJECTIVE: To determine the effect of race and ethnicity on the use of oral beta-agonists, inhaled beta-agonists, and inhaled corticosteroids to treat respiratory symptoms in former premature infants after controlling for medical conditions, socioeconomic status, and site of outpatient care.…
Incorporation of physiological trend and interaction effects in neonatal severity of illness scores: an experiment using a variant of the Richardson score
OBJECTIVE: To evaluate whether physiological trends and interaction terms could enhance predictive ability in a variant of the Richardson Score. METHOD: We conducted a retrospective cohort study using data from 2,222 newborns of 34 weeks or more gestation with respiratory…
Progress in pediatric asthma surveillance I: the application of health care use data in Alameda County, California
INTRODUCTION: The ability to conduct community-level asthma surveillance is increasingly crucial for public health programming and child health advocacy. We explored the potential and limitations of health care use records from both public and private sources for asthma surveillance in…
Risk factors and obstetric complications associated with macrosomia
OBJECTIVE: Macrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications. METHOD: Live births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care…
A computerized system to facilitate medical record abstraction in cancer research (United States)
OBJECTIVE: To implement a computerized system to gather and transmit medical record information from six sites to a centralized database for two cancer prevention studies. METHODS: Microsoft Access 97 was selected as the application for the system. Sites purchased Access…
Training, quality assurance, and assessment of medical record abstraction in a multisite study
Clinical studies using medical record review should include careful training and quality assurance methods to enhance the reliability and validity of data obtained from the records. Because of time and budget constraints, comprehensive assessments of data quality and reliability, including…
SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores
OBJECTIVES: Illness severity scores for newborns are complex and restricted by birth weight and have dated validations and calibrations. We developed and validated simplified neonatal illness severity and mortality risk scores. The primary outcome was in-hospital mortality. STUDY DESIGN: Thirty…
Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization
OBJECTIVE: To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization. DESIGN: Retrospective cohort study. SETTING: Eleven Northern California Kaiser Permanente hospitals. SUBJECTS: A total of 51,387 infants born in 1995-1996…
Cost-effectiveness of respiratory syncytial virus prophylaxis among preterm infants
OBJECTIVES: To evaluate the costs and benefits of two new agents, respiratory syncytial virus immune globulin (RSVIG) and palivizumab, to prevent respiratory syncytial virus (RSV) infection among premature infants discharged from the neonatal intensive care unit (NICU) before the start…
Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit
BACKGROUND: High-risk newborns are known to have higher than average utilization of services after discharge from the neonatal intensive care unit (NICU). Most studies on this subject report aggregate data over periods ranging from 1 to 3 years postdischarge. Little…
The neonatal ‘sepsis work-up’: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization
'Rule out sepsis' may be the most common discharge diagnosis among infants admitted to the neonatal intensive care unit. Although the frequency of sepsis, meningitis, and other confirmed bacterial infections has remained constant (between 1 and 5/1000 live births) for…
Structured review of neonatal deaths in a managed care organisation
We sought to quantify neonatal mortality (< 28 days) in a 10-hospital system, determine what proportion was associated with suboptimal neonatal care and make recommendations on how neonatal mortality rates (NMRs) could be used in quality improvement efforts. Deaths were…
