Douglas W Roblin
Datos Biográficos
| ID | 5534816 |
|---|---|
| NOMBRE | Douglas W Roblin |
| NOMBRES | Douglas W |
| APELLIDO | Roblin |
| FIRMA | ROBLIN D W |
| AFILIACIONES | Kaiser Permanente |
| VERIFICADO | No |
| TOTAL DE OBRAS | 25 |
| TOTAL DE CITAS | 0 |
| TOTAL COMO AUTOR | 25 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1992 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 0 |
Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients
BACKGROUND/OBJECTIVE: Evidence about the patient benefits of alternative primary care delivery models for high-cost/high needs patients is mixed. We conducted a follow-up study of a program designed to improve outcomes of seriously ill adult patients in an integrated delivery system. METHODS: Using a quasi-experimental design, we examined the 180-day mortality of patients empaneled to a complex care program (CCP, n=1445) compared with that of eli…
Factor Analysis in Distinguishing Coronavirus Disease 2019 From Other Influenza-like Illness Using a Validated Patient-Reported Outcome Instrument FLU-PRO Plus
BACKGROUND/OBJECTIVE: InFLUenza Patient-reported Outcome (FLU-PRO Plus) is a 34-item patient-reported outcome instrument designed to capture the intensity and frequency of viral respiratory symptoms. This study evaluates whether FLU-PRO Plus responses could discriminate between symptoms of coronavirus disease 2019 (COVID-19) and influenza-like illness (ILI) with no COVID diagnosis, as well as forecast disease progression. METHODS: FLU-PRO Plus wa…
Management of Neck or Back Pain in Ambulatory Care
BACKGROUND/OBJECTIVE: In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck …
Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the Covid-19 Pandemic Period
BACKGROUND/OBJECTIVE: In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. …
Impact of Covid-19 on Trends in Outpatient Clinic Utilization
BACKGROUND: The COVID-19 pandemic forced many US health care organizations to shift from mostly in-person care to a hybrid of virtual visits (VV) and in-person visits (IPV). While there was an expected and immediate shift to virtual care (VC) early in the pandemic, little is known about trends in VC use after restrictions eased. METHODS: This is a retrospective study using data from 3 health care systems. All completed visits from adult primary c…
Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the Covid-19 Pandemic
BACKGROUND: The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. METHODS: This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of…
Virtual Care and Urinary Tract Infection Management
BACKGROUND: During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES: We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person enco…
Development of a Common Data Model for a Multisite and Multiyear Study of Virtual Visit Implementation
BACKGROUND/OBJECTIVE: In multisite studies, a common data model (CDM) standardizes dataset organization, variable definitions, and variable code structures and can support distributed data processing. We describe the development of a CDM for a study of virtual visit implementation in 3 Kaiser Permanente (KP) regions. METHODS: We conducted several scoping reviews to inform our study's CDM design: (1) virtual visit mode, implementation timing, and …
Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the Covid-19 Pandemic
BACKGROUND: The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care. METHODS: A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was …
Evaluation of a Natural Language Processing Approach to Identify Social Determinants of Health in Electronic Health Records in a Diverse Community Cohort
BACKGROUND: Health care systems in the United States are increasingly interested in measuring and addressing social determinants of health (SDoH). Advances in electronic health record systems and Natural Language Processing (NLP) create a unique opportunity to systematically document patient SDoH from digitized free-text provider notes. METHODS: Patient SDoH status [recorded by Your Current Life Situation (YCLS) Survey] and associated provider no…
Considerations for Identifying Social Needs in Health Care Systems
Nau, Claudia PhD; Adams, John L. PhD; Roblin, Douglas PhD; Schmittdiel, Julie PhD; Schroeder, Emily MD, PhD, MSPH; Steiner, John F. MD, MPHAuthor Information
Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers
BACKGROUND: Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California…
The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization
BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs…
Racial Differences and Disparities in Osteoporosis-related Bone Health
BACKGROUND: Determining whether observed differences in health care can be called disparities requires persistence of differences after adjustment for relevant patient, provider, and health system factors. We examined whether providing dual-energy x-ray absorptiometry (DXA) test results directly to patients might reduce or eliminate racial differences in osteoporosis-related health care. DESIGN, SUBJECTS, AND MEASURES: We analyzed data from 3484 …
Health literacy–listening skill and patient questions following cancer prevention and screening discussions
OBJECTIVE: Patient question-asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question-asking as a function of health literacy with respect to spoken information (health literacy-listening). METHODS: Four-hundred and thirty-three (433) adults listened to simulated physician-patient interactions discussing (i) prophylacti…
Perception of community tolerance and prevalence of depression among transgender persons
Depression was common in this sample of transgender and gender non-conforming individuals and was strongly and consistently associated with participants' perceptions of community tolerance, even after adjusting for possible confounding. The association between desire to receive hormonal therapy and depression is a finding that warrants further exploration. Future research should also assess depression and changes in perception of community tolera…
Effect of Self-referral on Bone Mineral Density Testing and Osteoporosis Treatment
BACKGROUND: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening. OBJECTIVE: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referr…
Validation of a Neighborhood SES Index in a Managed Care Organization
BACKGROUND/OBJECTIVE: Neighborhood socioeconomic status (SES), beyond individual SES, has been associated with health behaviors and outcomes. We constructed a neighborhood SES index using readily available US Census variables and studied associations of the index with self-reported education, formal education, and neighborhood residential characteristics among adult enrollees of a managed care organization (MCO). METHODS: A neighborhood SES index…
Repeat Experience With the Doughnut Hole in Medicare Part D
OBJECTIVE: To describe the proportion of elderly Medicare advantage prescription drug plan (MAPDP) enrollees who meet or exceed the Medicare Part D doughnut hole (DH) entry threshold in 2 consecutive years and which characteristics put them at risk for repeated DH entry. SAMPLE: One cohort of MAPDP enrollees ≥65 years of age with at least 1 month of eligibility in both 2006 and 2007, and a second cohort of enrollees with at least 1 month of eligi…
Translating Primary Care Practice Climate into Patient Activation
BACKGROUND: Little is known about processes by which proactive primary care teams might activate their patients. We examine the role of trust in patient-physician relationships for translating practice teamwork into patient activation. METHODS: Data were collected by surveys of adult enrollees and primary care teams of a group-model managed care organization in metropolitan Atlanta. Enrollees who were 25-59 years of age were randomly sampled from…
Cluster Randomized Trials
BACKGROUND: Cluster randomized trials (CRTs) offer unique advantages over standard randomized controlled clinical trials (RCTs) and observational methodologies, and may provide a cost-efficient alternative for answering questions about the best treatments for common conditions. OBJECTIVES: To describe health plan leaders' views on CRTs, identify barriers to conducting CRTs, and solicit recommendations for increasing the acceptability of CRTs. RES…
Effect of Increased Cost-Sharing on Oral Hypoglycemic Use in Five Managed Care Organizations
BACKGROUND: For patients with a chronic disease, increased cost-sharing for medications may lead to unintended consequences, including reduced use of medications essential for control of their disease. OBJECTIVE: The objective of this study was to estimate the effects of small ($1-6 per 30-day supply), moderate ($7-10), and large (>$10) increases in medication cost-sharing on 12-month trends in oral hypoglycemic (OH) use among adults with type 2 …
Patient Satisfaction With Primary Care
OBJECTIVE: The objective of this study was to evaluate the association of patient satisfaction with type of practitioner attending visits in the primary care practice of a managed care organization (MCO). STUDY DESIGN: We conducted a retrospective observational study of 41,209 patient satisfaction surveys randomly sampled from visits provided by the pediatrics and adult medicine departments from 1997 to 2000. Logistic regression, with practitione…
A Low-Cost Approach to Prospective Identification of Impending High Cost Outcomes
OBJECTIVES: The overall objective of this study was to define and evaluate patterns of use of medical services in the care of patients with chronic illness that represent circumstances which, if modified, might lead to reduction in risk of acute-level care. METHODS: This was a retrospective observational study. The study population consisted of Kaiser Permanente enrollees at four sites during January 1993 through June 1995, who were 20 to 64 year…
Standards for peer evaluation
Required recertification of physicians has been proposed as a way to improve quality of care. Hospital medical staff quality assurance committees may be more meaningful targets for reform than individual physicians. Review standards are needed to make these committees effective monitors. Increasing regulatory attention to medical staff peer review can be expected
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Standards for peer evaluation
Required recertification of physicians has been proposed as a way to improve quality of care. Hospital medical staff quality assurance committees may be more meaningful targets for reform than individual physicians. Review standards are needed to make these committees effective monitors. Increasing regulatory attention to medical staff peer review can be expected
A Low-Cost Approach to Prospective Identification of Impending High Cost Outcomes
OBJECTIVES: The overall objective of this study was to define and evaluate patterns of use of medical services in the care of patients with chronic illness that represent circumstances which, if modified, might lead to reduction in risk of acute-level care. METHODS: This was a retrospective observational study. The study population consisted of Kaiser Permanente enrollees at four sites during January 1993 through June 1995, who were 20 to 64 year…
Patient Satisfaction With Primary Care
OBJECTIVE: The objective of this study was to evaluate the association of patient satisfaction with type of practitioner attending visits in the primary care practice of a managed care organization (MCO). STUDY DESIGN: We conducted a retrospective observational study of 41,209 patient satisfaction surveys randomly sampled from visits provided by the pediatrics and adult medicine departments from 1997 to 2000. Logistic regression, with practitione…
Effect of Increased Cost-Sharing on Oral Hypoglycemic Use in Five Managed Care Organizations
BACKGROUND: For patients with a chronic disease, increased cost-sharing for medications may lead to unintended consequences, including reduced use of medications essential for control of their disease. OBJECTIVE: The objective of this study was to estimate the effects of small ($1-6 per 30-day supply), moderate ($7-10), and large (>$10) increases in medication cost-sharing on 12-month trends in oral hypoglycemic (OH) use among adults with type 2 …
Cluster Randomized Trials
BACKGROUND: Cluster randomized trials (CRTs) offer unique advantages over standard randomized controlled clinical trials (RCTs) and observational methodologies, and may provide a cost-efficient alternative for answering questions about the best treatments for common conditions. OBJECTIVES: To describe health plan leaders' views on CRTs, identify barriers to conducting CRTs, and solicit recommendations for increasing the acceptability of CRTs. RES…
Translating Primary Care Practice Climate into Patient Activation
BACKGROUND: Little is known about processes by which proactive primary care teams might activate their patients. We examine the role of trust in patient-physician relationships for translating practice teamwork into patient activation. METHODS: Data were collected by surveys of adult enrollees and primary care teams of a group-model managed care organization in metropolitan Atlanta. Enrollees who were 25-59 years of age were randomly sampled from…
Repeat Experience With the Doughnut Hole in Medicare Part D
OBJECTIVE: To describe the proportion of elderly Medicare advantage prescription drug plan (MAPDP) enrollees who meet or exceed the Medicare Part D doughnut hole (DH) entry threshold in 2 consecutive years and which characteristics put them at risk for repeated DH entry. SAMPLE: One cohort of MAPDP enrollees ≥65 years of age with at least 1 month of eligibility in both 2006 and 2007, and a second cohort of enrollees with at least 1 month of eligi…
Validation of a Neighborhood SES Index in a Managed Care Organization
BACKGROUND/OBJECTIVE: Neighborhood socioeconomic status (SES), beyond individual SES, has been associated with health behaviors and outcomes. We constructed a neighborhood SES index using readily available US Census variables and studied associations of the index with self-reported education, formal education, and neighborhood residential characteristics among adult enrollees of a managed care organization (MCO). METHODS: A neighborhood SES index…
Effect of Self-referral on Bone Mineral Density Testing and Osteoporosis Treatment
BACKGROUND: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening. OBJECTIVE: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referr…
Health literacy–listening skill and patient questions following cancer prevention and screening discussions
OBJECTIVE: Patient question-asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question-asking as a function of health literacy with respect to spoken information (health literacy-listening). METHODS: Four-hundred and thirty-three (433) adults listened to simulated physician-patient interactions discussing (i) prophylacti…
Perception of community tolerance and prevalence of depression among transgender persons
Depression was common in this sample of transgender and gender non-conforming individuals and was strongly and consistently associated with participants' perceptions of community tolerance, even after adjusting for possible confounding. The association between desire to receive hormonal therapy and depression is a finding that warrants further exploration. Future research should also assess depression and changes in perception of community tolera…
The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization
BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs…
Racial Differences and Disparities in Osteoporosis-related Bone Health
BACKGROUND: Determining whether observed differences in health care can be called disparities requires persistence of differences after adjustment for relevant patient, provider, and health system factors. We examined whether providing dual-energy x-ray absorptiometry (DXA) test results directly to patients might reduce or eliminate racial differences in osteoporosis-related health care. DESIGN, SUBJECTS, AND MEASURES: We analyzed data from 3484 …
Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers
BACKGROUND: Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California…
Considerations for Identifying Social Needs in Health Care Systems
Nau, Claudia PhD; Adams, John L. PhD; Roblin, Douglas PhD; Schmittdiel, Julie PhD; Schroeder, Emily MD, PhD, MSPH; Steiner, John F. MD, MPHAuthor Information
Evaluation of a Natural Language Processing Approach to Identify Social Determinants of Health in Electronic Health Records in a Diverse Community Cohort
BACKGROUND: Health care systems in the United States are increasingly interested in measuring and addressing social determinants of health (SDoH). Advances in electronic health record systems and Natural Language Processing (NLP) create a unique opportunity to systematically document patient SDoH from digitized free-text provider notes. METHODS: Patient SDoH status [recorded by Your Current Life Situation (YCLS) Survey] and associated provider no…
Factor Analysis in Distinguishing Coronavirus Disease 2019 From Other Influenza-like Illness Using a Validated Patient-Reported Outcome Instrument FLU-PRO Plus
BACKGROUND/OBJECTIVE: InFLUenza Patient-reported Outcome (FLU-PRO Plus) is a 34-item patient-reported outcome instrument designed to capture the intensity and frequency of viral respiratory symptoms. This study evaluates whether FLU-PRO Plus responses could discriminate between symptoms of coronavirus disease 2019 (COVID-19) and influenza-like illness (ILI) with no COVID diagnosis, as well as forecast disease progression. METHODS: FLU-PRO Plus wa…
Management of Neck or Back Pain in Ambulatory Care
BACKGROUND/OBJECTIVE: In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck …
Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the Covid-19 Pandemic Period
BACKGROUND/OBJECTIVE: In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. …
Impact of Covid-19 on Trends in Outpatient Clinic Utilization
BACKGROUND: The COVID-19 pandemic forced many US health care organizations to shift from mostly in-person care to a hybrid of virtual visits (VV) and in-person visits (IPV). While there was an expected and immediate shift to virtual care (VC) early in the pandemic, little is known about trends in VC use after restrictions eased. METHODS: This is a retrospective study using data from 3 health care systems. All completed visits from adult primary c…
Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the Covid-19 Pandemic
BACKGROUND: The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. METHODS: This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of…
Virtual Care and Urinary Tract Infection Management
BACKGROUND: During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES: We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person enco…
Development of a Common Data Model for a Multisite and Multiyear Study of Virtual Visit Implementation
BACKGROUND/OBJECTIVE: In multisite studies, a common data model (CDM) standardizes dataset organization, variable definitions, and variable code structures and can support distributed data processing. We describe the development of a CDM for a study of virtual visit implementation in 3 Kaiser Permanente (KP) regions. METHODS: We conducted several scoping reviews to inform our study's CDM design: (1) virtual visit mode, implementation timing, and …
Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the Covid-19 Pandemic
BACKGROUND: The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care. METHODS: A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was …
Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients
BACKGROUND/OBJECTIVE: Evidence about the patient benefits of alternative primary care delivery models for high-cost/high needs patients is mixed. We conducted a follow-up study of a program designed to improve outcomes of seriously ill adult patients in an integrated delivery system. METHODS: Using a quasi-experimental design, we examined the 180-day mortality of patients empaneled to a complex care program (CCP, n=1445) compared with that of eli…
Medicine (21 obras) · Health care (16 obras) · Family medicine (15 obras) · Internal Medicine (13 obras) · Internal Medicine (13 obras) · MEDLINE (10 obras) · Nursing (10 obras) · Emergency Medicine (8 obras) · Emergency Medicine (8 obras) · Primary Care and Health Outcomes (7 obras)