Publications - Pharmacoeconomics Research

Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets

Wed, 24 Nov 2010 06:00:00 GMT

Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets Sohn, Min-Woong; Budiman-Mak, Elly; Stuck, Rodney M; Siddiqui, Farah; Lee, Todd A Background: As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method. Methods: Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003. Their electronic medical records were reviewed to verify whether the medical records positively indicate presence of a diabetic foot ulcer in diagnoses, medical assessments, or consults. For each method, five measures of accuracy and agreement were evaluated using data from medical records as the gold standard. Results: Our medical record reviews show that all methods had sensitivity > 92% but their specificity varied substantially between 74% and 91%. A method used in Harrington et al. (2004) was the most accurate with 94% sensitivity and 91% specificity and produced an annual prevalence of 3.3% among VA users with diabetes nationwide. A new and simpler method consisting of two codes (707.1× and 707.9) shows an equally good accuracy with 93% sensitivity and 91% specificity and 3.1% prevalence. Conclusions: Our results indicate that the Harrington and New methods are highly comparable and accurate. We recommend the Harrington method for its accuracy and the New method for its simplicity and comparable accuracy. © 2010 Sohn et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. doi:10.1186/1757-1146-3-27

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Wed, 29 Jun 2011 05:00:00 GMT

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care Joo, M.J.; Au, D.H.; Fitzgibbon, M.L.; McKell, J.; Lee, T.A. BACKGROUND: It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results. OBJECTIVES: To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry. DESIGN: Retrospective cohort study. SUBJECTS: A cohort that met the following criteria was identified: ≥35 years of age; ≥ 2 primary care visits in internal medicine clinic in 2007; at least one respiratory or smoking cessation medication, or diagnosis of COPD or shortness of breath or dyspnea in 2007. MAIN MEASURES: Medical records of all primary care physician visits prior to the time of inclusion in 2007 were reviewed. Data on patient demographics, co-morbidities, respiratory medication use, presence of symptoms, history of tobacco use, and pulmonary function tests were extracted. KEY RESULTS: A total 1052 patients were identified. Dyspnea on exertion (Adjusted odds ratio (AOR) 1.52 [95% CI 1.06-2.18]) and chronic cough (AOR 1.71 [1.07-2.72]) were the only chronic symptoms associated with use of spirometry. Current (AOR 1.54 [0.99-2.40]) or past smoking (AOR 1.09 [0.72-1.65]) status were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD. CONCLUSION: Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time. Post print version of article may differ from published version. The definitive version is available through Springer Verlag at DOI: 10.1007/s11606-011-1770-1 The original publication is available at www.springerlink.com

Cost is not a barrier to implementing clopidogrel pharmacogenetics

Sun, 01 Apr 2012 05:00:00 GMT

Cost is not a barrier to implementing clopidogrel pharmacogenetics Cavallari, Larisa H.; Schumock, Glen T. This is a copy of an article published in Pharmacotherapy © 2012 IOS Press. doi: 10.1002/j.1875-9114.2012.01107.x.

Comparison of Health-Related Quality of Life Measures in Chronic Obstructive Pulmonary Disease

Mon, 18 Apr 2011 05:00:00 GMT

Comparison of Health-Related Quality of Life Measures in Chronic Obstructive Pulmonary Disease Pickard, A. Simon; Yang, Yoojung; Lee, Todd A. Background: The aims of this study were: (1) to compare the discriminative ability of a disease-specific instrument, the St. George’s Respiratory Questionnaire (SGRQ) to generic instruments (i.e., EQ-5D and SF-36); and (2), to evaluate the strength of associations among clinical and health-related quality of life (HRQL) measures in chronic obstructive pulmonary disease (COPD). Methods: We analyzed data collected from 120 COPD patients in a Veterans Affairs hospital. Patients self-completed two generic HRQL measures (EQ-5D and SF-36) and the disease-specific SGRQ. The ability of the summary scores of these HRQL measures to discriminate COPD disease severity based on Global Obstructive Lung Disease (GOLD) stage was assessed using relative efficiency ratios (REs). Strength of correlation was used to further evaluate associations between clinical and HRQL measures. Results: Mean total scores for PCS-36, EQ-VAS and SGRQ were significantly lower for the more severe stages of COPD (p < 0.05). Using SGRQ total score as reference, the summary scores of the generic measures (PCS-36, MCS-36, EQ index, and EQ-VAS) all had REs of <1. SGRQ exhibited a stronger correlation with clinical measures than the generic summary scores. For instance, SGRQ was moderately correlated with FEV1 (r = 0.43), while generic summary scores had trivial levels of correlation with FEV1 (r < 0.2). Conclusions: The SGRQ demonstrated greater ability to discriminate among different levels of severity stages of COPD than generic measures of health, suggestive that SGRQ may provide COPD studies with greater statistical power than EQ-5D and SF-36 summary scores to capture meaningful differences in clinical severity. © 2011 Pickard et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The original version is available through BioMed Central at DOI: 10.1186/1477-7525-9-26.