The Addition of the Charlson Comorbidity Index to the GRACE Risk Prediction Index Improves Prediction of Outcomes in Acute Coronary Syndrome

Patients with cardiovascular disease have increased risk of poor outcomes when coexisting illnesses are present. Clinicians, administrators, and health services researchers utilize risk adjustment indices to stratify patients for various outcomes. The GRACE Risk Prediction Index (GRPI) was developed to risk stratify patients who experienced an acute coronary syndrome (ACS) event. GRPI does not account for the presence of comorbid conditions. The objective of this study was to compare the ability of the GRPI and the Charlson Comorbidity Index (CCI), used independently or combined, to predict mortality or secondary coronary events in patients admitted for ACS. Data were obtained from an academic health system's ACS registry. Outcomes included inpatient and 6-month postdischarge mortality and occurrence of secondary cardiovascular events or revascularization procedures. Logistic regression derived C statistics for CCI, GRPI, and CCI-GRPI predictive models for each outcome. Likelihood ratio tests determined the contribution of CCI when added to GRPI models. Complete data were available for 1202 patients. The GRPI model had the greatest C statistic when predicting inpatient mortality (0.73); the GRPI-CCI combined model C statistic was 0.81 when predicting death during the follow-up period; and C statistics for all 3 models were similar in predicting secondary events (0.57?0.60). The likelihood ratio analysis demonstrated that adding CCI to GRPI models was beneficial primarily for predicting secondary events. CCI is a useful addition to GRPI when predicting future cardiac-related events or mortality after an ACS event. It is an acceptable alternative to the GRPI model if data to construct GRPI are not available. (Population Health Management 2014;17:54?59)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140179/1/pop.2012.0117.pd

Comparison of Patient Outcomes Before and After Switching From Warfarin to a Direct Oral Anticoagulant Based on Time in Therapeutic Range Guideline Recommendations

This cohort study evaluates stroke and major bleeding rates before and after switching from warfarin to a direct oral anticoagulant (DOAC) in patients grouped by pre-switch time-in-therapeutic range guideline thresholds

Work‐Related Outcomes After a Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90385/1/phco.24.16.1515.50946.pd

Mapping Geographic Areas of High and Low Drug Adherence in Patients Prescribed Continuing Treatment for Acute Coronary Syndrome After Discharge

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90283/1/phco.31.10.927.pd

The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts

Background: Previous studies have shown race/ethnicity, particularly African American and/or Hispanic status, to be a predictor of overweight/obese status in children. However, these studies have failed to adjust for low socioeconomic status (SES). This study assessed whether race/ethnicity remained an independent predictor of childhood obesity when accounting for variations in SES (low-income) among communities in Massachusetts. Methods: This study was based on 2009 summarized data from 68 Massachusetts school districts with 111,799 students in grades 1, 4, 7, and 10. We studied the relationship between the rate of overweight/obese students (mean?=?0.32; range?=?0.10?0.46), the rate of African American and Hispanic students (mean?=?0.17; range?=?0.00?0.90), and the rate of low-income students (mean?=?0.27; range?=?0.02?0.87) in two and three dimensions. The main effect of the race/ethnicity rate, the low-income rate, and their interaction on the overweight and obese rate was investigated by multiple regression modeling. Results: Low-income was highly associated with overweight/obese status (p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140341/1/chi.2015.0029.pd

Sustainable Practices Within a School‐Based Intervention: A Report from Project Healthy Schools

Over the past three decades the proportion of students classified as overweight has almost tripled. This trend in childhood obesity is a cause for concern. Stakeholders have come together to stem growth and implement healthy habits in childhood to not only prevent obesity, but also future cardiovascular risk. School‐based health interventions have proven to be an effective medium to reach youth. Sustainable practices remain the largest determinant of long‐term success of these programs. Project Healthy Schools, a community–university collaborative school‐based health intervention program, sustainable practices have led to positive changes in participating middle schools. This collaborative has provided important insight on key factors needed for long‐term sustainability for a school‐based wellness program. These key factors are described under leadership, policy, finances, and reproducibility. Future school‐based programs may plan for success with sustainability while drawing from our experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96375/1/wmh36.pd

Health‐Related Quality of Life in Patients 7 Months After a Myocardial Infarction: Factors Affecting the Short Form‐12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90293/1/phco.22.17.1616.34121.pd

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixedâ methods study

BackgroundOutpatient anticoagulation clinics were initially developed to care for patients taking vitamin K antagonists such as warfarin. There has not been a systematic evaluation of the barriers and facilitators to integrating direct oral anticoagulant (DOAC) care into outpatient anticoagulation clinics.MethodsWe performed a mixed methods study consisting of an online survey of anticoagulation clinic providers and semiâ structured interviews with anticoagulation clinic leaders and managers between March and May of 2017. Interviews were transcribed and coded, exploring for themes around barriers and facilitators to DOAC care within anticoagulation clinics. Survey questions pertaining to the specific themes identified in the interviews were analyzed using summary statistics.ResultsSurvey responses were collected from 159 unique anticoagulation clinics and 20 semiâ structured interviews were conducted. Three primary barriers to DOAC care in the anticoagulation clinic were described by the interviewees: (a) a lack of provider awareness for ongoing monitoring and services provided by the anticoagulation clinic; (b) financial challenges to providing care to DOAC patients in an anticoagulation clinic model; and (c) clinical knowledge versus scope of care by the anticoagulation staff. These themes linked to three key areas of variation, including: (a) the size and hospital affiliation of the anticoagulation clinic; (b) the use of faceâ toâ face versus telephoneâ based care; and (c) the use of nurses or pharmacists in the anticoagulation clinic.ConclusionsAnticoagulation clinics in the United States experience important barriers to integrating DOAC care. These barriers vary based on the clinic size, model for warfarin care, and staff credentials (nursing or pharmacy).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/1/rth212157.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/2/rth212157_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/3/rth212157-sup-0001-Supinfo.pd