Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance

Objectives. We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence.Methods. Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses.Results. We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts.Conclusions. Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence.In its 2012 report on measures for population health, the Institute of Medicine prioritized understanding local population health to improve health care for populations with the highest need.1 Generally, health care providers have used the term “population health” when referring to patients linked to a specific health care provider or insurance group.2 However, the discipline of public health more broadly defines population health as the health of all individuals living in specific geographic regions.3To estimate disease burden, traditional methods include performing population-based telephone health surveys.4 Unless large numbers of individuals are surveyed, it is difficult to determine prevalence in small geographic areas such as census tracts, and yearly estimates have significant noise because of small sample sizes.5 Low response rates can lead to errors in estimating disease prevalence, and larger surveys can be costly and difficult to perform.6With increasing use of big data in the form of large administrative data sets with clinical data,7 there is an opportunity to create more precise measures of population health by reducing the variance associated with small sample sizes.8–10 These methods may be biased as they only track individuals who register a medical claim, which makes for a type of convenience sample. Nevertheless, a significant proportion of all individuals, regardless of insurance type, interact with the health care system, especially through emergency services. Nearly 1 in 5 individuals report having gone to an emergency department (ED) in the past year.11 Previous studies have demonstrated the promise of using emergency claims data for tracking acute illnesses; however, there is potential to extend these methods to the surveillance of chronic disease.12,13 One of the advantages of using administrative claims data is the achievement of large sample sizes without the need to conduct large surveys.14,15In this study, we have introduced a novel geographic method of public health surveillance and determined whether we could use ED administrative claims to estimate chronic disease prevalence at a local level over time. As the ED is generally a place where all individuals can access care regardless of socioeconomic or insurance status, it offers an ideal environment for public health surveillance among all types of individuals within a heterogeneous population.16     

The Perceived Relationship Knowledge Scale: An Initial Validation

The rationale, development, and initial validation of the Perceived Relationship Knowledge Scale (PRKS), a brief six‐item instrument designed to measure central aspects of perceptions of relationship knowledge, are described in this article. To test the instrument's psychometric properties, two studies were conducted: an exploratory study with a small clinical sample (n = 54; Study 1), and the second with a sample of participants in a statewide relationship education initiative (n = 2,183; Study 2). In both studies, exploratory factor analyses yielded a single‐factor structure. Maximum‐likelihood confirmatory factor analyses in Study 2 indicated good internal consistency and good model fit. Analyses of construct validity in both studies indicated that the PRKS measures relationship knowledge in psychometrically expected ways, and that the instrument discriminates low versus high levels of perceived relationship knowledge. The use of the instrument is described and research implications are discussed.     

A randomized,double-blind study of SHP465 mixed amphetamine salts extended-release in adults with ADHD using a simulated adult workplace design

Objectives: The objective of this paper was to evaluate the efficacy, duration of effect, and tolerability of SHP465 mixed amphetamine salts (MAS) extended-release versus placebo and immediate-release MAS (MAS IR) in adults with attention-deficit/hyperactivity disorder (ADHD).

Methods: Adults with ADHD Rating Scale, Version IV (ADHD-RS-IV) scores ≥24 were randomized to SHP465 MAS (50 or 75 mg), placebo, or 25 mg MAS IR in a double-blind, three-period, crossover study using a simulated adult workplace environment. On the final day of each 7-day treatment period, efficacy was assessed for 16 h postdose. Primary efficacy analyses for Permanent Product Measure of Performance (PERMP) total score averaged across all postdose assessments and each postdose time point were conducted in the intent-to-treat population using a mixed linear model. Secondary end-points included PERMP problems attempted and answered correctly and ADHD-RS-IV scores based on clinician ratings of counselor observations using the Time Segment Rating System and participant self-report. Tolerability assessments included treatment-emergent adverse events (TEAEs) and vital signs.

Results: Least squares mean (95% CI) treatment differences (combined 50/75 mg SHP465 MAS–placebo) significantly favored SHP465 MAS over placebo for PERMP total score averaged across all postdose assessments (18.38 [11.28, 25.47]; P < .0001) and at each postdose assessment (all P < .02). Nominal superiority of MAS IR over placebo for PERMP total score averaged across all postdose assessments was observed (nominal P = .0001); treatment differences between SHP465 MAS and MAS IR were not significant (nominal P = .2443). The two most frequently reported TEAEs associated with SHP465 MAS were insomnia (36.5%) and anorexia (21.2%). Mean increases in pulse and blood pressure with SHP465 MAS exceeded those of placebo.

Conclusions: SHP465 MAS (combined 50/75 mg) significantly improved PERMP total score versus placebo, with superiority observed from 2 to 16 h postdose. The tolerability profile of SHP465 MAS was similar to previous reports of SHP465 MAS in adults with ADHD.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00928148 identifier is NCT00928148.     

The effect of intravenous insulin,apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis

Objectives: There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics predictive of lipid-lowering therapy selection in a large community hospital for treatment of hypertriglyceridemia; evaluate for a concentration-dependent relationship between hypertriglyceridemia severity and risk of acute pancreatitis; assess for differences in clinical outcomes between patients treated with IV insulin versus apheresis.

Methods: Single center, retrospective cohort study including patients with hypertriglyceridemia between January 2007 and December 2016. Main measures included frequency of pancreatitis, choice of lipid-lowering therapy, and clinical comparisons of diet, oral lipid-lowering agents, IV insulin, and apheresis.

Results: Initial serum triglyceride level and disease acuity was higher among patients in insulin and apheresis groups. Neither triglyceride level, Charlson comorbidity index, age, BISAP score, nor initial CRP predicted use of IV insulin versus apheresis. Prevalence of pancreatitis increased with higher triglyceride level, reaching 48% with triglycerides >2000 md/dL (p < 0.001). There was a significant decrease in serum triglycerides at each time interval (p < 0.05) in patients treated with IV insulin and apheresis, but no difference in clearance rate between the two. Length of stay did not differ between IV insulin and apheresis.

Conclusion: The presence of pancreatitis, hyperglycemia, and hypertriglyceridemia severity influenced selection of therapies like IV insulin and apheresis. We found no superiority of either IV insulin or apheresis in the treatment of severe hypertriglyceridemia among patients hospitalized for pancreatitis.