Mouneer Odeh

Background: Informatics infrastructures at most academic cancer centers consist of a largely random amalgamation of poorly documented, inadequately quality-assured, minimally intercommunicating, and often duplicative data repositories. The lack of a well-organized infrastructure increases cost and decreases productivity associated with multiple cancer-related activities, and constitutes a significant barrier to collaborative research both within and between institutions, in large part because… Show more

Background: Informatics infrastructures at most academic cancer centers consist of a largely random amalgamation of poorly documented, inadequately quality-assured, minimally intercommunicating, and often duplicative data repositories. The lack of a well-organized infrastructure increases cost and decreases productivity associated with multiple cancer-related activities, and constitutes a significant barrier to collaborative research both within and between institutions, in large part because the various data repositories are nearly always based on different underlying data models. To address these issues, the National Cancer Institute and its collaborators developed a broad-based data model called the Biomedical Research Integrated Domain Group (BRIDG) model. A primary purpose of the BRIDG model is to provide an international standard data model to facilitate collaborative cancer research both within and between institutions. Methods: Over the past four years the Cancer Bioinformatics team at the Thomas Jefferson University Sidney Kimmel Cancer Center has designed and implemented the first iteration of a highly quality-assured, multipurpose, BRIDG-harmonized cancer research information system. Results: Cost reduction and productivity enhancement are beginning to be achieved by consolidating multiple data capturing, data cleaning, and data retrieval efforts for multiple patient care, teaching, research, administrative, and regulatory activities. Conclusions: The NCI-sponsored BRIDG model can be instantiated into a multipurpose academic cancer information system that can reduce costs and increase productivity by combining data capturing, data cleaning, and data retrieval for multiple patient care, teaching, research, and administrative activities simultaneously. To our knowledge, this is the first BRIDG-harmonized multipurpose cancer research information system instantiated at a U.S. academic Cancer Center. Show less

Background—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices.

Methods and… Show more

Background—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices.

Methods and Results—We selected individuals with ≥2 months of INR data, INR results of >1.2, and an ICD-9 diagnosis
code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with <6 months of testing to 57.5% for those with ≥6 months of testing (P<0.0001). The number of patients tested per physician practice was positively associated with time in the therapeutic range. Younger age, female sex, and lower income were also independently associated with poorer anticoagulant control.

Conclusion—This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States. Show less

Abstract

Objectives

We report annual trends in low density lipoprotein cholesterol (LDL-C) from an in-care patient population of nearly 105 million adults across the United States (U.S.), from 2001 through 2011.

Background

Average blood cholesterol values have declined in the U.S. since at least 1960. The National Health and Nutrition Examination Survey (NHANES) reported declining blood cholesterol values from 1999 through 2010. In the absence of more recent… Show more

Abstract

Objectives

We report annual trends in low density lipoprotein cholesterol (LDL-C) from an in-care patient population of nearly 105 million adults across the United States (U.S.), from 2001 through 2011.

Background

Average blood cholesterol values have declined in the U.S. since at least 1960. The National Health and Nutrition Examination Survey (NHANES) reported declining blood cholesterol values from 1999 through 2010. In the absence of more recent published data, we examined LDL-C values from a single clinical laboratory database to determine whether these values continued to decline through 2011.

Methods and Results

We extracted almost 247 million LDL-C results from nearly 105 million adults who received diagnostic testing from a single national clinical laboratory. Annual age-adjusted mean LDL-C values were calculated, and analyzed by gender. Piecewise regression analysis of the total study population indicates a breakpoint, or change in slope, in the years following 2008 (F = 163.13; p<0.05). Between 2001 and 2008, the average rate of annual decline was −2.05 mg/dL (95% CI [−2.35, −1.75]). After 2008, mean LDL-C levels flattened out, with a slope not statistically different from zero (slope = −0.10 mg/dL/year; 95% CI [−1.46, 1.26]). This stabilization was observed in both genders and all age ranges, and was also reflected in the percentage of results in low- and high-risk categories.

Conclusions

The trends reported suggest historical progress in decreasing LDL-C levels, observed from 2001–2008, may have stalled in recent years. Further research is needed to determine the cause of the observed trends and develop new strategies to reduce lipid-based cardiovascular risk further. Show less

Key findings include:
• Prescription drug misuse continues to be highly prevalent. About 60% of patients failed to use their prescription drugs as indicated by their ordering physician in 2012, compared to 63% in 2011. Despite increased public attention on the epidemic of prescription drug abuse in recent years, our data suggests prescription drug misuse continues to be a healthcare concern for a significant percentage of patients prescribed opioids, sedatives, stimulants and other… Show more

Key findings include:
• Prescription drug misuse continues to be highly prevalent. About 60% of patients failed to use their prescription drugs as indicated by their ordering physician in 2012, compared to 63% in 2011. Despite increased public attention on the epidemic of prescription drug abuse in recent years, our data suggests prescription drug misuse continues to be a healthcare concern for a significant percentage of patients prescribed opioids, sedatives, stimulants and other medications.
• Marijuana was the most misused drug. Non-prescribed marijuana was detected in more than one in four patients (26%) with inconsistent test results. These findings confirm other research that demonstrates that marijuana is the most commonly abused illicit drug in the United States.
• Recreational marijuana users were more likely than non-users to
misuse other drugs. Nearly half (45%) of patients who used marijuana
recreationally also used other non-prescribed drugs—most commonly
sedatives and narcotic pain killers—compared to approximately one third (36%) of non-marijuana users. These findings build on prior research correlating recreational marijuana use with other forms of drug abuse. In addition, prescribed marijuana users were not significantly more likely to inappropriately use other drugs.
• Recreational marijuana users were not more likely than non-users to divert or skip medications. Based on test results, recreational marijuana users were as likely as non-users to not use their prescription medications. A patient may not take a prescribed drug due to financial constraints and diversion, including illegal drug sales. Show less

Key findings include:
• The majority of patients tested misused their prescription medications, potentially putting their health at risk. Test results of the majority of patients (63%) were inconsistent with a physician’s orders. Comparable rates of inconsistency were found among all commonly prescribed drug classes tested.
• Many patients took or combined additional drugs without physician oversight. Of those patients whose results were inconsistent, more than half (60%) tested… Show more

Key findings include:
• The majority of patients tested misused their prescription medications, potentially putting their health at risk. Test results of the majority of patients (63%) were inconsistent with a physician’s orders. Comparable rates of inconsistency were found among all commonly prescribed drug classes tested.
• Many patients took or combined additional drugs without physician oversight. Of those patients whose results were inconsistent, more than half (60%) tested positive for drugs not specified by the ordering physician. This finding demonstrates that a large number of patients are using drugs, potentially in dangerous combinations, without the oversight of a trained healthcare professional.
• A large number of patients showed no drug in their specimen. In 40% of inconsistent cases, no drug was detected. This finding suggests many patients are failing to take their prescription medication as directed, possibly due to financial constraints (medications too costly), poor
compliance or diversion (illegal sale).
• Anyone is at risk of misuse. While some groups, such as the very young, were more likely to misuse, our data suggests that women and men of all ages are at risk, regardless of income level and health plan membership.
• Repeat testing was associated with lower prescription drug misuse. Among patients tested 30 days or more after an initial screen, the number of patients with inconsistent results declined by 10%. Our data supports medical recommendations that physicians perform routine urine testing
to monitor prescription drug misuse. Show less

Background—Vitamin D deficiency is highly prevalent and associated with dyslipidemia and cardiovascular disease. The impact is unknown of correcting vitamin D deficiency on blood lipids.

Methods and Results— 4.06 million de-identified patient laboratory test results were analyzed from September 2009 through February 2011. We performed a cross-sectional study of this population to determine associations between 25-hydroxyvitamin D levels and lipids across clinically defined strata. We… Show more

Background—Vitamin D deficiency is highly prevalent and associated with dyslipidemia and cardiovascular disease. The impact is unknown of correcting vitamin D deficiency on blood lipids.

Methods and Results— 4.06 million de-identified patient laboratory test results were analyzed from September 2009 through February 2011. We performed a cross-sectional study of this population to determine associations between 25-hydroxyvitamin D levels and lipids across clinically defined strata. We also conducted a retrospective cohort study of vitamin D deficient patients to investigate how changes in 25-hydroxyvitamin D levels relate to changes in lipid levels. After exclusions, 108,711 patients with serial testing were selected for cross-sectional analysis. Compared to vitamin D deficient patients (<20 ng/ml), those with optimal levels (≥30 ng/ml) had lower mean total cholesterol (-1.9 mg/dl [95% CI (-1.2, -2.7 mg/dl)]; p <.0001), lower LDL cholesterol (-5.2 mg/dl [95% CI (-4.5, -5.8 mg/dl)]; p <.0001), higher HDL cholesterol (4.8 mg/dl [95% CI (4.5, 5.0 mg/dl)]; p <.0001), and lower triglycerides (-7.5 mg/dl [95% CI (-6.2, -8.7 mg/dl)]; p <.0001). For the retrospective cohort analysis, raising vitamin D levels from <20 ng/ml to ≥30 ng/ml (n = 6,260), compared to those remaining <20 ng/ml (n = 2,332), was associated with a mean increase in total cholesterol (0.77 mg/dl [95% CI (0.18, 1.36 mg/dl)]; p = .01) and HDL cholesterol (0.42 mg/dl [95% CI (0.08, 0.76 mg/dl)]; p = 0.02), but non-significant changes in LDL cholesterol (0.32 mg/dl [95% CI (-0.01, 0.66 mg/dl)]; p = .06) and triglycerides (0.04 mg/dl [95% CI (-2.16, 2.23 mg/dl)]; p = .97)

Conclusions—While vitamin D deficiency is associated with an unfavorable lipid profile in cross-sectional analyses, correcting for a deficiency might not translate into clinically meaningful changes in lipid concentrations, although data from intervention trials is required to confirm these findings. Show less

Background

We evaluated the ability of HRA-laboratory testing to provide new disease-risk information to participants.

Methodology/Principal Findings

We performed a cross-sectional analysis of HRA-laboratory results for participating adult employees and their eligible spouses or their domestic partners, focusing on three common health conditions: hyperlipidemia, diabetes mellitus, and chronic kidney disease. HRA with laboratory results of 52,270 first-time participants were… Show more

Background

We evaluated the ability of HRA-laboratory testing to provide new disease-risk information to participants.

Methodology/Principal Findings

We performed a cross-sectional analysis of HRA-laboratory results for participating adult employees and their eligible spouses or their domestic partners, focusing on three common health conditions: hyperlipidemia, diabetes mellitus, and chronic kidney disease. HRA with laboratory results of 52,270 first-time participants were analyzed. Nearly all participants had access to health insurance coverage. Twenty-four percent (12,392) self-reported one or more of these medical conditions: 21.1% (11,017) self-identified as having hyperlipidemia, 4.7% (2,479) self-identified as having diabetes, and 0.7% (352) self-identified as having chronic kidney disease. Overall, 36% (n = 18,540) of participants had laboratory evidence of at least one medical condition newly identified: 30.7% (16,032) had laboratory evidence of hyperlipidemia identified, 1.9% (984) had laboratory evidence of diabetes identified, and 5.5% (2,866) had laboratory evidence of chronic kidney disease identified. Of all participants with evidence of hyperlipidemia 59% (16,030 of 27,047), were newly identified through the HRA. Among those with evidence of diabetes 28% (984 of 3,463) were newly identified. The highest rate of newly identified disease risk was for chronic kidney disease: 89% (2,866 of 3,218) of participants with evidence of this condition had not self-reported it.

Conclusions/Significance

These results support the important role of employer-sponsored laboratory testing as an integral element of HRA for identifying evidence of previously undiagnosed common medical conditions in individuals of all working age ranges, regardless of educational level and gender. Show less