An Intersectional Analysis of Social Deprivation and Patient Characteristics on Nirmatrelvir-Ritonavir for Treatment of COVID-19 in U.S. Primary Care Practices, 2021 to 2023.

Objective: Calculate rates of nirmatrelvir-ritonavir prescription and assess area-level social deprivation as an effect modifier of patient characteristics on nirmatrelvir-ritonavir for the treatment of COVID-19.

Methods: Retrospective cohort study December 22, 2021 to June 30, 2023 using electronic health record (EHR) data of primary care patients from the American Family Cohort (AFC). Eligible patients had documented COVID-19 between December 15, 2021 and February 28, 2023; ≥1 healthcare encounter between January 1, 2020 and December 14, 2021; and ≥1 healthcare encounter between December 15, 2021 and June 30, 2023.

Decreasing Utilization of Vaginal Hysterectomy in the United States: An Analysis by Candidacy for Vaginal Approach.

Introduction And Hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach.

Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion.

Plasmapheresis in ANCA-Associated Vasculitis with Active Kidney Involvement in the United States (2016-2020): A Cross-Sectional Study.

Key Points: Plasmapheresis is recommended for treating ANCA-associated vasculitis with severe renal and/or lung involvement. We established the cohort being admitted for ANCA-associated vasculitis with active kidney involvement from the 2016–2020 National Inpatient Sample. We described characteristics, inpatient procedures, lengths of stay, hospital costs, and disposition for patients treated with plasmapheresis.

Predictors of same-day discharge following benign minimally invasive hysterectomy.

Background: Same-day discharge following minimally invasive hysterectomy has been shown to be safe and feasible in select populations, but many nonclinical factors influencing same-day discharge remain unexplored.

Objective: To develop prediction models for same-day discharge following minimally invasive hysterectomy using both clinical and nonclinical attributes and to compare model concordance of individual attribute groups.

Study Design: We performed a retrospective study of patients who underwent elective minimally invasive hysterectomy for benign gynecologic indications at 69 hospitals in a statewide quality improvement collaborative between 2012 and 2019.

Physical and occupational therapy utilization and associated factors among adults with cerebral palsy: Longitudinal modelling to capture distinct utilization groups.

Background: Adults with cerebral palsy (CP) experience functional declines. Clinical rehabilitation may preserve function for this population.

Objective: To identify longitudinal physical/occupational therapy use and associated factors among adults with CP, to inform health promotion strategies.

Development of a Preoperative Clinical Risk Assessment Tool for Postoperative Complications After Hysterectomy.

Study Objective: To develop a preoperative risk assessment tool that quantifies the risk of postoperative complications within 30 days of hysterectomy.

Design: Retrospective analysis.

Setting: Michigan Surgical Quality Collaborative hospitals.

Development of a new comorbidity index for adults with cerebral palsy and comparative assessment with common comorbidity indices.

Aim: To develop a new comorbidity index for adults with cerebral palsy (CP), the Whitney Comorbidity Index (WCI), which includes relevant comorbidities for this population and better predicts mortality than the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI).

Method: Data from the Optum Clinformatics Data Mart was used for this retrospective cohort study. Diagnosis codes were used to identify adults aged 18 years or older with CP (n=1511 females, n=1511 males; mean [SD; range] age=48y [19y 2mo; 18-89y]) and all comorbidities in the year 2014.

Advanced CKD Among Adults With Cerebral Palsy: Incidence and Risk Factors.

Rationale & Objective: Recent evidence suggests that adults with cerebral palsy have an elevated risk for developing advanced chronic kidney disease (CKD). To develop effective interventions, the objective was to identify whether demographics and preexisting medical conditions are risk factors for advanced CKD among adults with cerebral palsy.

Study Design: Retrospective cohort study.

Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department.

Importance: Appendicitis may be missed during initial emergency department (ED) presentation.

Objective: To compare patients with a potentially missed diagnosis of appendicitis (ie, patients with symptoms associated with appendicitis, including abdominal pain, constipation, nausea and/or vomiting, fever, and diarrhea diagnosed within 1-30 days after initial ED presentation) with patients diagnosed with appendicitis on the same day of ED presentation to identify factors associated with potentially missed appendicitis.

Design, Setting, And Participants: In this cohort study, a retrospective analysis of commercially insured claims data was conducted from January 1 to December 15, 2019.

Early-Onset Noncommunicable Disease and Multimorbidity Among Adults With Pediatric-Onset Disabilities.

Objective: To determine the prevalence of major noncommunicable diseases among young adults with pediatric-onset disabilities (PoDs) compared with young adults without PoDs.

Patients And Methods: Data were obtained from the Optum Clinformatics Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the United States. Beneficiaries were included if they were 18 to 40 years old and had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for a PoD known to originate in childhood.

Elevated fracture risk for adults with neurodevelopmental disabilities.

Background: Fracture is a high-burden condition that accelerates unhealthful aging and represents a considerable economic burden. Adults with neurodevelopmental disabilities (NDDs) may be susceptible for fracture at younger ages compared to adults without NDDs; and yet, very little is known about the burden of fracture for these underserved populations. The purpose of this study was to determine the sex-stratified prevalence of all-cause fracture among adults with NDDs, as compared to adults without NDDs, and if comorbidity of NDDs is associated with greater risk of fracture.

Prevalence of high-burden medical conditions and health care resource utilization and costs among adults with cerebral palsy.

Individuals with cerebral palsy (CP) are susceptible to early development of high-burden medical conditions, which may place a considerable strain on health care resources. However, little is known about the prevalence of high-burden medical conditions or health care resource utilization among adults with CP. The purpose of this study was to determine the prevalence of high-burden medical conditions and health care resource utilization and costs among adults with CP, as compared to adults without CP.

Prevalence of Mental Health Disorders Among Adults With Cerebral Palsy: A Cross-sectional Analysis.

Background: Persons with cerebral palsy (CP) have an increased risk for secondary chronic conditions during childhood, including mental health disorders. However, little is known about how these disorders affect adults with CP.

Objective: To determine the prevalence of mental health disorders among adults with CP compared with those without CP.

Impact of a National Private Health Insurer's Prior Authorization Policy on Utilization of Vaginal Hysterectomy.

Objectives: On April 6, 2015, the largest private health insurer in the United States implemented a policy requiring prior authorization for all hysterectomies except those done as outpatient vaginal. The purpose of this policy was to increase utilization of vaginal hysterectomy; however, it is unknown whether this policy had its intended effect. We sought to analyze trends in hysterectomy routes before and after implementation of the prior authorization policy to see if utilization of vaginal hysterectomy increased.

Hospital contribution to variation in rates of vaginal birth after cesarean.

Objective: To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).

Study Design: This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included.

Importance of Estimated Blood Loss in Resource Utilization and Complications of Hysterectomy for Benign Indications.

Objective: To identify the variation in estimated blood loss at the time of hysterectomy for benign indications and to analyze how blood loss is associated with measures of resource utilization and complications.

Methods: We conducted a retrospective cohort study and analyzed hysterectomy for benign indications at hospitals in the Michigan Surgical Quality Collaborative between January 1, 2013, and May 30, 2015. A sensitivity analysis was performed to identify how estimated blood loss was associated with measures of utilization (transfusion, readmission, reoperation, and length of stay) and postoperative complications.

Academic Hospitals Discharge Fewer Patients to Postacute Care Facilities After Colorectal Resection.

Background: Discharge to a nonhome destination (ie, skilled nursing facility, subacute rehabilitation, or long-term care facility) after surgery is associated with increased mortality and higher costs and is less desirable to patients than discharge to home.

Objective: We sought to identify modifiable hospital-level factors that may reduce rates of nonhome discharge after colorectal resection.

Design: This was a retrospective cohort study of patients undergoing colorectal resection in the Michigan Surgical Quality Collaborative (July 2012 to June 2015).

Impact of the Image Gently® Campaign on Computerized Tomography Use for Evaluation of Pediatric Nephrolithiasis.

Purpose: The Image Gently® campaign was launched by several radiological societies in 2007 to promote safe imaging in children. A goal of the campaign was to reduce ionizing radiation exposure in children. Given the recurrent nature of kidney stones, affected children are at risk for unnecessary ionizing radiation exposure from computerized tomography.

Preoperatively predicting non-home discharge after surgery for gynecologic malignancy.

Objective: Returning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy.

Methods: Women who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database.

Acute Care Surgery Model and Outcomes in Emergency General Surgery.

Background: Annually, more than 2 million patients are admitted with emergency general surgery (EGS) conditions. Emergency general surgery cases comprise 11% of all general surgery operations, yet account for 47% of mortalities and 28% of complications. Using the statewide general surgery Michigan Surgical Quality Collaborative (MSQC) data, we previously confirmed that wide variations in EGS outcomes were unrelated to case volume/complexity.

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse.

Objectives: To (1) determine the proportion of hysterectomy cases with documentation of pessary counseling prior to prolapse surgery and (2) identify variables associated with women offered a pessary.

Study Design: The Michigan Surgical Quality Collaborative (MSQC) is a hysterectomy improvement initiative. Hysterectomies from 2013 to 2015 in which prolapse was the principal diagnosis were included.

Definition development and prevalence of new persistent opioid use following hysterectomy.

Background: Opioids used for postoperative pain control after surgery have been associated with an increased risk of chronic opioid use. Hysterectomy is the most common major gynecological procedure in the United States; however, we lack a data-driven definition of new persistent opioid use specific to hysterectomy.

Objective: The objectives of the study were as follows: (1) determine a data-driven definition of new persistent opioid use among opioid naïve women undergoing hysterectomy and (2) determine the prevalence of and risk factors for new persistent opioid use.