scholarly journals Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the MAAGE Study in the United States

2021 ◽  
Author(s):  
Rachel M Burke ◽  
Claire Mattison ◽  
Zachary Marsh ◽  
Kayoko Shioda ◽  
Judy Donald ◽  
...  
Keyword(s):  
United States ◽  
Active Surveillance ◽  
Acute Gastroenteritis ◽  
Stool Specimen ◽  
Healthcare Delivery ◽  
Healthcare Setting ◽  
The United States ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Antibiotics Use

Abstract Background Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus. Methods Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014 – June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into one episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping. Results The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged <5 years (20.4 episodes per 1000 PY), followed by adults aged ≥65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY, astrovirus: 1.3 per 1000 PY, rotavirus: 0.5 per 1000 PY). Conclusions Viral enteropathogens, particularly norovirus, are an important contributor to MAAGE, especially among children <5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.

scholarly journals 1107. The MAAGE Study: Health Care Utilization for the Treatment of Medically Attended Acute Gastroenteritis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S331-S332
Author(s):  
Claire P Mattison ◽  
Holly Groom ◽  
Judy Donald ◽  
S Bianca Salas ◽  
Zachary Marsh ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Acute Gastroenteritis ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Care Utilization ◽  
Comorbid Condition ◽  
Inpatient Setting ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Demographic Patterns

Abstract Background Acute gastroenteritis (AGE) exacts a substantial disease burden across the age spectrum, although healthcare utilization for AGE is not well characterized. Through active surveillance of medically attended acute gastroenteritis (MAAGE) encounters within a large, integrated healthcare delivery system, we analyzed demographic patterns of healthcare utilization among AGE patients. Methods From April 1, 2014 to September 30, 2016, we collected information on all MAAGE encounters in Kaiser Permanente Northwest (KPNW) patients through daily abstraction from electronic health records using ICD-9/-10 codes. For each patient, a MAAGE episode was defined as all MAAGE encounters <30 days apart. Results There were 109,493 MAAGE encounters among 39,451 patients. Patients were 60.4% female and 39.6% male; 10.3% were <5 years old, 9.7% were 5–17, 31.1% were 18–44, 25.4% were 45–64, and 23.5% were ≥65. Among those with known race, 87.2% were white; 4.1% were Asian, 3.6% were black, and 5.1% were other or multiple races. Prevalence of any chronic comorbid condition was 52.9%. Of 52,107 MAAGE episodes, 81.0% first presented as outpatients; this was most common in those aged <5 (92.1%) and decreased with age to 75.0% in those ≥65. First presenting remotely (email or telephone) ranged from 4.0% in those aged <5 to 19.3% in those ≥65; 52.7% of episodes first presenting remotely had no subsequent visits. Few episodes first presented to an emergency department (3.8% in <5 year olds to 6.6% in 18–44 year olds) or inpatient setting (0.1% in <5 year olds to 1.7% in ≥65 year olds). Most MAAGE episodes comprised of one encounter (median: 1.0, mean: 2.1). The number of encounters per episode was lowest in those <5 years old (median: 1.0, mean: 1.5) and highest in those ≥65 (median: 2.0, mean: 2.5). Most deaths within 30 days from the start of an episode (131/161) were in those ≥65; there were none in those <5, 1 in those 5–17, 5 in those 18–44, and 24 in those 45–64. Conclusion We found that the number of encounters per MAAGE episode increased with age and that outpatient and remote encounters are important settings for the initial clinical management of MAAGE in all ages. These data can help to better quantify the economic burden of AGE and guide appropriate delivery of healthcare services. Disclosures All authors: No reported disclosures.

Healthcare in the United States

2018 ◽  
pp. 73-85
Author(s):  
Hillary Knepper
Keyword(s):  
United States ◽  
Healthcare Delivery ◽  
Basic Structure ◽  
The United States ◽  
Healthcare Industry ◽  
Healthcare Delivery System ◽  
Patient Protection ◽  
Public Revenue ◽  
The Impact ◽  
The U.S

Healthcare in the United States is a dynamic mix of public and marketplace solutions to the challenge of achieving the maximum public good for the greatest number of people. Indeed, in the U.S. the healthcare industry generates over $3 trillion in the economy. This creates a uniquely American paradox that is examined here. The basic structure of the U.S. public-private healthcare delivery system is explored. The dynamics of public sector involvement in healthcare delivery is reviewed, with particular emphasis on the impact of the Patient Protection and Affordable Care Act. Economic impact, employment indicators, and recent cost estimates of public revenue investment will be considered. Finally, a discussion about the future implications of healthcare for public administration in the 21st century is presented. Eight tables and figures present a visual and detailed explanation to accompany the narrative.

Healthcare in the United States

2021 ◽  
pp. 480-491
Author(s):  
Hillary Knepper
Keyword(s):  
United States ◽  
Healthcare Delivery ◽  
Basic Structure ◽  
The United States ◽  
Healthcare Industry ◽  
Healthcare Delivery System ◽  
Patient Protection ◽  
Public Revenue ◽  
The Impact ◽  
The U.S

Healthcare in the United States is a dynamic mix of public and marketplace solutions to the challenge of achieving the maximum public good for the greatest number of people. Indeed, in the U.S. the healthcare industry generates over $3 trillion in the economy. This creates a uniquely American paradox that is examined here. The basic structure of the U.S. public-private healthcare delivery system is explored. The dynamics of public sector involvement in healthcare delivery is reviewed, with particular emphasis on the impact of the Patient Protection and Affordable Care Act. Economic impact, employment indicators, and recent cost estimates of public revenue investment will be considered. Finally, a discussion about the future implications of healthcare for public administration in the 21st century is presented. Eight tables and figures present a visual and detailed explanation to accompany the narrative.

scholarly journals Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System

2018 ◽  
Vol 131 (7) ◽  
pp. 829-836.e1 ◽  
Author(s):  
Stephen Sidney ◽  
Michael E. Sorel ◽  
Charles P. Quesenberry ◽  
Marc G. Jaffe ◽  
Matthew D. Solomon ◽  
...  
Keyword(s):  
United States ◽  
Heart Disease ◽  
Delivery System ◽  
Healthcare Delivery ◽  
The United States ◽  
Healthcare Delivery System ◽  
Integrated Healthcare ◽  
All Cause Mortality

scholarly journals Su1266 – Helicobacter Pylori Testing and Treatment in a Large, Integrated Healthcare Delivery System in the United States

2019 ◽  
Vol 156 (6) ◽  
pp. S-524 ◽  
Author(s):  
Nimish Vakil ◽  
Steven N. Michalopoulos ◽  
Alexander Zajichek ◽  
Tao Wang ◽  
Janine Bauman ◽  
...  
Keyword(s):  
United States ◽  
Helicobacter Pylori ◽  
Delivery System ◽  
Healthcare Delivery ◽  
The United States ◽  
Healthcare Delivery System ◽  
Integrated Healthcare

scholarly journals Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

PLoS ONE ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. e0148395 ◽  
Author(s):  
Scott P. Grytdal ◽  
Emilio DeBess ◽  
Lore E. Lee ◽  
David Blythe ◽  
Patricia Ryan ◽  
...  
Keyword(s):  
United States ◽  
Acute Gastroenteritis ◽  
The United States ◽  
Kaiser Permanente ◽  
Viral Pathogens

scholarly journals Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study

2020 ◽  
Author(s):  
Joseph A. Lewnard ◽  
Vincent X. Liu ◽  
Michael L. Jackson ◽  
Mark A. Schmidt ◽  
Britta L. Jewell ◽  
...  
Keyword(s):  
United States ◽  
Clinical Outcomes ◽  
Healthcare Delivery ◽  
The United States ◽  
Washington State ◽  
Reproductive Number ◽  
Kaiser Permanente ◽  
Icu Admission ◽  
Duration Of Hospitalization ◽  
Intervention Impact

ABSTRACTBackgroundThe United States is now the country reporting the highest number of 2019 coronavirus disease (COVID-19) cases and deaths. However, little is known about the epidemiology and burden of severe COVID-19 to inform planning within healthcare systems and modeling of intervention impact.MethodsWe assessed incidence, duration of hospitalization, and clinical outcomes of acute COVID-19 inpatient admissions in a prospectively-followed cohort of 9,596,321 individuals enrolled in comprehensive, integrated healthcare delivery plans from Kaiser Permanente in California and Washington state. We also estimated the effective reproductive number (RE) describing transmission in the study populations.ResultsData covered 1277 hospitalized patients with laboratory- or clinically-confirmed COVID-19 diagnosis by April 9, 2020. Cumulative incidence of first COVID-19 acute inpatient admission was 10.6-12.4 per 100,000 cohort members across the study regions. Mean censoring-adjusted duration of hospitalization was 10.7 days (2.5-97.5%iles: 0.8-30.1) among survivors and 13.7 days (2.5-97.5%iles: 1.7-34.6) among non-survivors. Among all hospitalized confirmed cases, censoring-adjusted probabilities of ICU admission and mortality were 41.9% (95% confidence interval: 34.1-51.4%) and 17.8% (14.3-22.2%), respectively, and higher among men than women. We estimated RE was 1.43 (1.17-1.73), 2.09 (1.63-2.69), and 1.47 (0.07-2.59) in Northern California, Southern California, and Washington, respectively, for infections acquired March 1, 2020. RE declined to 0.98 (0.76-1.27), 0.89 (0.74-1.06), and 0.92 (0.05-1.55) respectively, for infections acquired March 20, 2020.ConclusionsWe identify high probability of ICU admission, long durations of stay, and considerable mortality risk among hospitalized COVID-19 cases in the western United States. Reductions in RE have occurred in conjunction with implementation of non-pharmaceutical interventions.

How Research Will Adapt to HIPAA: A View from Within the Healthcare Delivery System

2002 ◽  
Vol 28 (4) ◽  
pp. 491-502
Author(s):  
Mary L. Durham
Keyword(s):  
Health Information ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
The United States ◽  
Personal Health Information ◽  
Personal Health ◽  
Business Associations ◽  
Electronic Information ◽  
Healthcare Delivery System ◽  
Institutional Review

While the new Health Insurance Privacy and Accountability Act (HIPAA) research rules governing privacy, confidentiality and personal health information will challenge the research and medical communities, history teaches us that the difficulty of this challenge pales in comparison to the potential harms that such regulations are designed to avoid. Although revised following broad commentary from researchers and healthcare providers around the country, the HIPAA privacy requirements will dramatically change the way healthcare researchers do their jobs in the United States. Given our reluctance to change, we risk overlooking potentially valid reasons why access to personal health information is restricted and regulated. In an environment of electronic information, public concern, genetic information and decline of public trust, regulations are ever-changing. Six categories of HIPAA requirements stand out as transformative: disclosure accounting/tracking, business associations, institutional review board (IRB) changes, minimum necessary requirements, data de-identification, and criminal and civil penalties.

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