Intermountain Healthcare is a not-for-profit healthcare system and is the largest healthcare provider in the Intermountain West of the United States. Intermountain Healthcare provides ambulatory and acute health services, along with other medical services, through 225 clinics and 25 hospitals in Utah, Idaho, Nevada and additional affiliations in other areas. It also offers integrated managed care under the insurance brand "SelectHealth." Intermountain Healthcare is headquartered in Salt Lake City, Utah, and has more than 42,000 employees.Intermountain and Colorado-based SCL Health announced that they completed their merger on April 1st, 2022. The combined system employs than 58,000 people and operates 33 hospitals.
Background HIV testing opportunities are often missed during urgent care (UC) and emergency department (ED) evaluations for sexually transmitted infections. We implemented a multimodal diagnostic stewardship intervention to increase HIV testing in UC and ED gonorrhea (GC)/chlamydia (CT) testing encounters ("HIV co-testing"). Methods We conducted a pre-/post implementation study across 26 UCs and 22 EDs in our health system (April 2022-March 2024). The intervention included system-wide simultaneous implementation of provider and patient education and a link-to-care program for newly diagnosed people with HIV (PWH) and patients needing additional testing, followed by phased activation of an electronic health record alert prompting HIV co-testing. We estimated the impact of the intervention on HIV GC/CT co-testing using interrupted time series analysis, measured alert engagement, and described the impact of the link-to-care program. Results By the end of the intervention period, HIV GC/CT co-testing rates were 12.7% points higher in UC (95% CI 6.2-19.2), a 41.9% relative increase (P < .001) compared with preintervention trends. In the ED, co-testing rates rose 12.3% points (95% CI 1.08-23.6), a 53.4% relative increase (P = .02). A total of 4704 alerts fired, resulting in 730 alert-associated HIV co-tests. During the intervention, 17 PWH were newly diagnosed: 5 (29%) were due to alert-associated co-tests. All PWH and those requiring additional testing received prompt linkage to care. Conclusions HIV GC/CT co-testing increased in UC and ED during our intervention, leading to new HIV diagnoses and linkage to care. Integrating HIV co-testing into GC/CT testing encounters improved HIV screening practices in our large health system.
Psoriatic arthritis (PsA) is characterized by heterogeneous musculoskeletal manifestations. The aim of this post-hoc cluster analysis from the ULTIMATE study was to explore whether objective assessment of inflammation, using power-Doppler ultrasound (PDUS), identified homogeneous groups of patients based on the level of severity of ultrasound-detected synovitis and then to determine the longitudinal trajectory of response with secukinumab vs. placebo for each cluster up to week 12. The ULTIMATE study enrolled patients with PsA and active clinical and PDUS synovitis. Patients were randomized to either secukinumab 150 or 300 mg, according to psoriasis severity, or placebo for the first 12 weeks. Multiple factor analysis was performed on baseline B-mode and power Doppler (PD) signal core components of the composite Global EULAR-OMERACT synovitis score (GLOESS) at joint level. Three clusters were identified from all patients enrolled in the ULTIMATE study (N = 166), with 49 (30
Purpose: Children with neonatal intensive care unit (NICU) admission have higher rates of genetic disease, but it is unclear which patients should have genetic testing. Our goal was to identify clinical predictors associated with a pathogenic genetic result in NICU infants. Methods: This was a retrospective, population-based cohort analysis of infants born between January 1, 2009 and June 30, 2011 with a history of NICU admission and subsequent follow-up and genetic testing through 2021. Results: A total of 99 infants met inclusion criteria. In total, 64 (65%) patients had a negative genetic test result; 35 (35%) had a positive (pathogenic) result. Lower birthweight, younger gestational age, longer length of stay, or 2 or more indicators of severe illness were associated with a pathogenic result. Conclusion: Our work suggests that clinical predictors can be used to guide genetic testing in NICU infants. Use of these clinical risk factors could provide a diagnostic care pathway, potentially shortening the diagnostic odyssey and reducing potential morbidities.
ABSTRACT Background and Objectives Leukodystrophies are neurogenetic diseases affecting the white matter of the central nervous system. The contributing factors for leukodystrophy mortality are incompletely understood. Our objectives were to characterize inpatient deaths of pediatric leukodystrophies, including demographics and risk factors. Methods This retrospective cohort analysis utilized the national Pediatric Health Information System (PHIS) database. Patients under age 19 years with an (ICD‐10) diagnosis of leukodystrophy and an inpatient encounter at a PHIS hospital between 2016 and 2024 were included. Analysis included descriptive and multivariate statistics. Results In all, 613 patients with 15 different leukodystrophies were identified; 32 patients died (5.2%). The most common diagnoses of patients who died were Krabbe disease (KD) (31%), adrenoleukodystrophy (ALD) (28%), metachromatic leukodystrophy (MLD) (28%), and vanishing white matter disease (VWM) (6%). Volume of leukodystrophy admissions at individual hospitals was inversely correlated with mortality. Small numbers limited statistical significance, but mortality rates were higher in females than males (8.3% vs. 3.8%); and Black, Asian, and multiracial patients were more likely to die than White patients, 8.4%, 7.7%, and 8.7%, versus 4.1%. Conclusions In this large national administrative database study, we characterized and helped define risks for inpatient mortality of pediatric leukodystrophies. Inpatient mortality was correlated with clinical risk factors, and further, although small numbers precluded statistical significance, mortality disparities by sex and race were identified. The reasons for these differences are not known and warrant further study. Our findings identify directions for new research and underscore the potential impact of specialized institutional experience.
PURPOSE:The Targeted Agent and Profiling Utilization Registry Study is a phase II basket trial evaluating the antitumor activity of commercially available targeted agents in patients with advanced cancer and genomic alterations. Results of a cohort of patients with ovarian cancer (OC) with CDKN2A alterations treated with palbociclib are reported. METHODS:Eligible patients had advanced OC, measurable disease (RECIST), Eastern Cooperative Oncology Group performance status 0-2, adequate organ function, tumors with CDKN2A alterations, and no remaining standard treatment options. The primary end point was disease control (DC), defined as objective response (OR) or stable disease (SD) of at least 16+ weeks duration (SD16+). Simon two-stage design with a null DC rate of 15% versus 35% (power = 0.85; α = .10) was used. Secondary end points included OR, progression-free survival (PFS), overall survival (OS), duration of response, duration of SD, and safety. RESULTS:Twenty-eight patients were enrolled from February 2017 to April 2023, and all had OC with a CDKN2A alteration (loss [n = 21], mutation [n = 5], and loss and mutation [n = 2]). One patient was not evaluable for efficacy because of an excluded genomic finding. Three patients had a partial response and seven had SD16+ for DC and OR rates of 38% (90% CI, 25 to 100) and 11% (95% CI, 2 to 29), respectively. The null hypothesis of 15% DC rate was rejected (P = .004). The median PFS was 8 weeks (95% CI, 8 to 18) and the median OS was 33 weeks (95% CI, 24 to 73). Nineteen patients (68%) had at least one treatment-related grade 3-4 adverse event (AE) or serious AE including anemia, dyspnea, fatigue, leukopenia, neutropenia, and thrombocytopenia. CONCLUSION:Palbociclib met the prespecified criteria to declare a signal of activity in patients with OC and CDKN2A alterations.
