Adamson, Steven C.

As medical providers seek new ways to control costs, online visits have begun to receive serious consideration. The purpose of this study was to compare the odds of being a cost outlier during a 6-month period after either an online visit or a standard drop-in visit in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who had an online visit ( N = 390) and a comparison group who had regular office care for same-day, acute visits ( N = 376). Case types were classified as either complex or common, with common being defined as treatment for pinkeye, sore throat, viral illness, bronchitis, or cough. Outliers were defined as patients for whom standard costs exceeded the 75 th percentile during a 6-month period after the index visit. Multiple logistic regression analysis was used to adjust for differences between groups. The percentage of online visitors who were cost outliers was 21.2 (versus 28.5 in the standard visit group). Median standard costs were $161 for online visits and $219 for same-day acute visits. The adjusted odds of being a cost outlier was lower for the online visit group than for the standard visit group (odds ratio [OR] 0.52, 95% confidence interval [95% CI] 0.35–0.77) after adjusting for number of visits in the previous 6 months, age, sex, and case type. Outpatient visits in the previous 6 months were positively related to outlier status (OR 1.23, 95% CI 1.17–1.29). Online visits appeared to reduce medical costs for patients during a 6-month period after the visit. ( Population Health Management 2010;13:59–63)

The purpose of this study was to assess whether the relationship between obesity and use of medical visits is different for geriatric patients than for other adults. A retrospective analysis was conducted using medical records drawn from a large group practice in Rochester, Minnesota. Adult patients ( n = 1715) were sorted into 2 groups (frequent visitors and others). Separate multiple logistic regression models were estimated for geriatric and non-geriatric patients. Patients who were 65 years of age or older with moderate comorbidity had elevated odds of being frequent visitors (odds ratio [OR] = 6.13, confidence interval [CI] = 3.27–11.49), compared to patients with no comorbidity. Body mass index (BMI), gender, and marital status were unrelated to visit frequency in the geriatric group. Younger patients with a BMI ≥ 35 kg/m 2 had greater odds of being frequent visitors compared to patients with normal body mass, after adjusting for comorbidity, age, marital status, and gender (OR = 1.96, CI = 1.31–2.92). ORs also were significantly greater for subjects with low (OR = 2.13, CI = 1.51–3.01) and moderate comorbidity (OR = 3.32, CI = 2.32–4.76) versus no comorbidity. In our sample of family medicine patients who were referred to specialists, BMI ≥ 35 kg/m 2 is an independent risk factor for frequent utilization of medical visits among adults who are younger than age 65, but not among geriatric patients. Comorbidity is strongly related to visit frequency among both older and younger adult patients. (Population Health Management 2008;11:255–259)

Objective: To assess the association between self-assessed stair-climbing limitation and weight control among family medicine patients, after adjustment for age, gender, marital status, body mass index (BMI), and co-morbidity. Methods: This study was a retrospective analysis of a cohort of 840 adult family medicine patient records drawn from a large family medicine department in Rochester, Minnesota. Weight control was measured as no change or decline in BMI over approximately 1 year. Results: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that limited stair-climbing ability was unrelated to weight control over approximately 1 year. Instead, patients with BMI ≥ 30 were more likely to control their weight (p<0.01), and age exhibited a non-linear relationship with weight control. The odds of weight control were lower for patients between the ages of 36 and 45 years than for those aged 18—35 years (p<0.01). Conclusions: In our sample of family medicine patients, self-assessed stair-climbing limitations did not preclude weight control. Weight gain prevention programmes might be targeted at patients who are entering middle age.

ABSTRACT We compared the performance characteristics of a real-time PCR method, the LightCycler Strep-A assay (Roche Applied Science, Indianapolis, Ind.), to those of a rapid antigen immunoassay, the Directigen 1-2-3 Group A Strep Test kit (BD Diagnostic Systems, Sparks, Md.), and a standard culture method for detection of group A streptococci (GAS) from 384 throat swabs. The LightCycler PCR produced more positive results ( n = 58) than either culture ( n = 55) or the Directigen immunoassay ( n = 31). The results of the LightCycler PCR and the Directigen method were independently compared to the results of the accepted “gold standard,” bacterial culture. The sensitivities, specificities, and positive and negative predictive values for this comparison were as follows: for the Directigen method, 55, 99, 97, and 93%, respectively; for the LightCycler PCR, 93, 98, 88, and 99%, respectively. In no case was a throat swab positive by both the LightCycler PCR and the Directigen method but negative by culture. The medical histories of patients whose throat swabs were negative by culture but positive by either the LightCycler PCR ( n = 7) or the Directigen method ( n = 1) were reviewed. All of these patients had signs or symptoms compatible with GAS disease, and therefore, all of these discordant positive results (along with positive results by either the Directigen method or the LightCycler PCR that agreed with the culture results) were counted as true positives for statistical analysis. For this analysis, the LightCycler PCR detected more true-positive results than the culture method (58 versus 55 swabs); however, this difference was not statistically significant ( P = 0.5465). In contrast, statistically significantly more true-positive results occurred by culture than by the Directigen method (55 versus 31 swabs; P < 0.0001) and by the LightCycler PCR than by the Directigen method (58 versus 31 swabs; P < 0.0001). The LightCycler PCR is a suitable stand-alone method for the detection of GAS from throat swabs. Additionally, this method requires less than half the personnel time and the procedure can be completed in considerably less time (∼1 h) than our standard approach (up to 2 days) for detection of GAS in throat swabs (i.e., testing by the Directigen method with negative results verified by culture).