Turning Identity into Form: The Cause and Consequence for Kaiser Permanente of becoming an HMO

We investigated HMO members' use of complementary and alternative medicine (CAM) providers outside the HMO in 1995-1996. A random 2% survey of Kaiser Permanente Northwest members addressed HMO service satisfaction, self-reported health status and behaviors, and HMO utilization. Among respondents, 15.7% (n = 380) used CAM providers (chiropractors, naturopaths, acupuncturists, others) in the prior 12 months, while 35% were ever users. Multivariate analysis found that those more likely to consult CAM providers were females, more educated, and more dissatisfied with the HMO. These results suggest that HMOs may wish to focus efforts to improve patient satisfaction among CAM service users.

Download Full-text

Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 811-818

Author(s):

Nicole B. Kurata ◽

Keith K. Ogasawara ◽

Kathryn L. Pedula ◽

William A. Goh

Keyword(s):

Perinatal Outcomes ◽

Kaiser Permanente ◽

Second Stage Of Labor ◽

Second Stage ◽

Labor Duration ◽

Nulliparous Women ◽

Multiparous Women ◽

Comparison Groups ◽

Maternal And Neonatal Outcomes ◽

Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

Download Full-text

Same-Day versus Conventional Different-Day Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy: A Multi-Center Retrospective Study

The American Surgeon ◽

10.1177/000313481808401029 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1679-1683

Author(s):

Mohammed H. Al-Temimi ◽

Charles Trujillo ◽

Mital Shah ◽

Sriram Rangarajan ◽

Edwin Kim ◽

...

Keyword(s):

Gastric Bypass ◽

Success Rate ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Postoperative Morbidity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Endoscopic Retrograde ◽

Kaiser Permanente ◽

Estimated Blood Loss ◽

Baseline Characteristics

Same-day endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (LC) could potentially reduce hospital length of stay (HLOS). Patients undergoing same-day procedures (N = 164) between 2012 and 2014 were compared with different-day procedures performed in the second half of 2014 (N = 276), in the Kaiser Permanente Southern California database. Both groups had comparable baseline characteristics. ERCP success rate (97.5% vs 93.5%), overall postoperative morbidity (3.66% vs 3.99%), and retained stones (2.5% vs 5.8%) were not different between groups ( P > 0.05); however, HLOS was shorter in the same-day group (2.99 ± 2.34 vs 3.84 ± 2.52 days, P < 0.001). Morbidity, procedure success, and HLOS were not different in the same-day group, whether ERCP was performed before or after LC ( P > 0.05). In the same-day group, those undergoing single anesthesia had higher BMI (40.1 ± 10.8 vs 30.3 ± 6.6) and were more likely to have gastric bypass (30% vs 0%) than those undergoing separate anesthesia sessions ( P < 0.01). Longer HLOS (4.8 ± 3.5 vs 2.9 ± 2.2 days) and higher estimated blood loss (65 ± 90 mL vs 20 ± 29 mL) were also associated with the single-anesthetic session ( P < 0.01). ERCP performed on the same day of LC reduces HLOS without increasing morbidity. This approach does not affect postoperative morbidity and ERCP success rate, whether ERCP was performed before or after LC.

Download Full-text

Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente Commentary: Funding is not the only factor Commentary: Same price, better care Commentary: Competition made them do it

BMJ ◽

10.1136/bmj.324.7330.135 ◽

2002 ◽

Vol 324 (7330) ◽

pp. 135-143 ◽

Cited By ~ 165

Author(s):

R. G A Feachem

Keyword(s):

Kaiser Permanente

Download Full-text

A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.220 ◽

2015 ◽

Vol 36 (12) ◽

pp. 1409-1416 ◽

Cited By ~ 23

Author(s):

Sara Y. Tartof ◽

Gunter K. Rieg ◽

Rong Wei ◽

Hung Fu Tseng ◽

Steven J. Jacobsen ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Southern California ◽

Skilled Nursing Facility ◽

Antibiotic Exposure ◽

Kaiser Permanente ◽

Nursing Facility ◽

Skilled Nursing ◽

Transfer Factors ◽

Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

Download Full-text