Medical Technology And Practice Patterns Institute Inc

Gilead co-us-998-7081 evaluating gender specific disparities in the viral hepatitis cascade:in this period the primary objective was to examine timely treatment of chronic hepatitis b (chb) given the reduction in risks of cirrhosis and hepatocellular carcinoma. Gaps in timely treatment have historically persisted, especially among underserved safety-net populations. We aimed to evaluate gaps and disparities in chb treatment in the united states. Adults with treatment-naive chb without human immunodeficiency virus were identified from 2010 to 2018 across 3 safety-net health systems. Chb treatment eligibility was assessed using american association for the study of liver diseases (aasld) criteria and alternative criteria, including the simplified approach for hepatitis b algorithm. Differences in chb treatment between groups were evaluated using ?2 methods, adjusted kaplan-meier methods, and adjusted cox proportional hazards models.we found that among 3749 patients with treatment-naive chb (51.5% women, 38.7% white, 33.7% african american, 19.6% asian, 24.6% cirrhosis), 30.0% were aasld treatment eligible, among whom 31.0% were treated. Men were more likely than women to be treated (33.5% vs 26.6%, p < .01). On multivariable regression, there remained a trend toward greater treatment in men versus women (adjusted hazard ratio [ahr], 1.21 [95% confidence interval {ci}, .96-1.54]). Disparities by race/ethnicity and insurance status were observed. When exploring outcomes using saba criteria, similar trends were observed. Among treatment-eligible patients, greater likelihood of treatment was observed in men versus women (ahr, 1.40 [95% ci, 1.14-1.70]) and in asians versus whites (ahr, 1.50 [95% ci, 1.16-1.94]). We concluded that among an ethnically diverse multicenter safety-net cohort of chb patients, less than one-third of treatment-eligible patients received antiviral treatment. Significant disparities in chb treatment were observed by sociodemographic characteristics. These findings resulted in a publication as follows: wong rj, jain mk, niu b, therapondos g, kshirsagar o, thamer m. Sociodemographic disparities in hepatitis b treatment: a real-world analysis of 3 safety-net health systems in the united states. Open forum infect dis. 2024 oct 1;11(10):ofae571. Doi: 10.1093/ofid/ofae571. Ecollection 2024 oct. Pmid: 39411222

Nimhd r01 md017063-01 racial and ethnic disparities in hcc surveillancein 2024, we focused on two research aims: aim 1 was to evaluate gaps and disparities in hcc surveillance among adults with cirrhosis across four safety-net health systems in the u.s. We identified adults with cirrhosis from march 1, 2017 to february 28, 2022 across four safety-net health systems in california, florida, ohio, and texas. Cirrhosis was identified using established definitions based on icd-9/10 codes. Patients with baseline hcc diagnosis were excluded. The primary outcome was receipt of hcc surveillance imaging (ultrasound, ct, or mri scans of the abdomen) within first 6 months (hcc6mo) of cirrhosis diagnosis during the study period. Among a multi-center safety-net cohort of cirrhosis patients, over 70% received some form of abdominal imaging within 6 months, but less than 30% received imaging specifically for an indication of hcc surveillance. We concluded that significant disparities in hcc surveillance were observed across sociodemographic factors. These findings were presented at the 2024 american association for the study of liver diseases (aasld) conference: gaps and disparities in hepatocellular carcinoma surveillance among a multi-center safety-net cohort of adults with cirrhosis. Robert j. Wong, patricia jones, bolin niu, paulo pinheiro, mae thamer5, onkar kshirsagar, yi zhang, et al. Poster presentation at aasld november 2024 san diego convention center san diego ca.aim 2 was to evaluate clinician-level factors contributing to underuse of hcc surveillance in patients with cirrhosis. Surveillance for hepatocellular carcinoma (hcc) in patients with cirrhosis is underused. We sought to identify potentially modifiable factors to address barriers in hcc surveillance is critical to improve patient outcomes. We conducted a survey study that included primary care clinicians (pccs) and gastroenterology and hepatology clinicians at 5 safety-net health systems in the us. Clinicians were surveyed from march 15 to september 15, 2023, to assess knowledge, attitudes, beliefs, perceived barriers, and covid-19-related disruptions in hcc surveillance in patients with cirrhosis. The main outcome measures were hcc surveillance knowledge that was assessed with 6 questions querying the respondent's ability to correctly identify appropriate use of hcc surveillance. Attitudes, perceived barriers, and beliefs regarding hcc surveillance and perceived impact of the covid-19 pandemic-related disruptions with hcc surveillance were assessed with a series of statements using a 4-point likert scale and compared pccs and gastroenterology and hepatology clinicians.overall, 347 of 1362 clinicians responded to the survey (25.5% response rate), among whom 142 of 237 (59.9%) were pccs, 48 of 237 (20.3%) gastroenterology and hepatology, 190 of 236 (80.5%) were doctors of medicine and doctors of osteopathic medicine, and 46 of 236 (19.5%) were advanced practice clinicians. On hcc knowledge assessment, 144 of 270 (53.3%) scored 5 or more of 6 questions correctly, 37 of 48 (77.1%) among gastroenterology and hepatology vs 65 of 142 (45.8%) among pccs (p < .001). Those with higher hcc knowledge scores were less likely to report barriers to hcc surveillance. Pccs were more likely to report inadequate time to discuss hcc surveillance (37 of 139 [26.6%] vs 2 of 48 [4.2%]; p = .001), difficulty identifying patients with cirrhosis (82 of 141 [58.2%] vs 5 of 48 [10.4%]; p < .001), and were not up-to-date with hcc surveillance guidelines (87 of 139 [62.6%] vs 5 of 48 [10.4%]; p < .001) compared with gastroenterology and hepatology clinicians. While most acknowledged delays during the covid-19 pandemic, 62 of 136 pccs (45.6%) and 27 of 45 gastroenterology and hepatology clinicians (60.0%) reported that patients with cirrhosis could currently complete hcc surveillance without delays. We concluded that in this survey study, important gaps in knowledge and perceived barriers to hcc surveillance were identified. Effective delivery of hcc education to pccs and health system-level interventions must be pursued in parallel to address the complex barriers affecting suboptimal hcc surveillance in patients with cirrhosis. We published the following paper based on this research: wong rj, jones pd, niu b, therapondos g, thamer m, kshirsagar o, zhang y, pinheiro p, kyalwazi b, fass r, khalili m, singal ag. Clinician-level knowledge and barriers to hepatocellular carcinoma surveillance. Jama netw open. 2024 may 1;7(5):e2411076. Doi: 10.1001/jamanetworkopen.2024.11076. Pmid: 38743424

Hospital acquired infections in hemodialysis populationmtppi researchers worked as subcontractors to lifespan health to research hospital acquired infections in hemodialysis patient population.

Amgen 16465587169 cadaveric kidney transplantation outcomes among dialysis and gout patientsin 2024, mtppi continued its collaboration with amgen examining the role of gout across the dialysis-waitlist-transplant continuum in the united states. Specifically, using usrds standard analytic files from 2016-2021 linked with medicare claims and transplant registry data, the team finalized construction of three national longitudinal cohorts representing incident dialysis patients, transplant waitlist candidates, and first kidney transplant recipients. Monthly expanded data structures were developed to model gout as a time-varying exposure based on validated icd-10 codes, while capturing contemporaneous changes in hospitalization patterns, cardiovascular events, and comorbidity burden. These data supported implementation of marginal structural models with stabilized inverse-probability weights to address confounding from both baseline and time-varying clinical factors.the analyses performed in 2024 revealed that gout is associated with consistently adverse outcomes across the kidney failure and transplant continuum. Among patients initiating dialysis, gout was linked to substantially higher mortality and a reduced five-year cumulative probability of transplant waitlisting, despite non-significant adjusted cause-specific hazard ratios for waitlisting itself. Among waitlisted candidates, gout was associated with a lower likelihood of receiving a deceased-donor kidney transplant and elevated waitlist mortality. Among transplant recipients, gout was associated with higher risk of death-censored graft failure as well as higher post-transplant mortality. These findings were robust in sensitivity analyses and represent the most comprehensive national evaluation to date of gout as a risk factor for worse outcomes in eskd and transplant populations.in 2024, the project's analytic progress resulted in the acceptance of two national abstracts reflecting dissemination of the dialysis and waitlist/transplant findings:national kidney foundation / ajkd (accepted 2024) parajuli s, zhang y, marder b. Association of gout with access to kidney transplant waitlisting among hemodialysis patients. Published as abstract #g-574 in ajkd; presented at nkf spring clinical meetings 2025. Doi:10.1053/j.ajkd.2025.02.575american society of nephrology kidney week (accepted 2024) gout is associated with worse wait-list outcomes in patients on dialysis awaiting kidney transplant. Abstract fr-po0973, asn kidney week 2025. Doi:10.1681/asn.2025k2d0smekthese abstract acceptances in 2024 reflect the scientific readiness and completeness of the project's analytic work during the year. Additional materials, including a full manuscript integrating the dialysis, waitlist, and transplant results, were drafted in late 2024. Overall, the 2024 accomplishments underscore gout as an important, underrecognized contributor to mortality, transplant access barriers, and graft failure risk across the kidney transplant continuum.

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