Kaiser Permanente Northwest (KPNW) serves over 440 000 members, approximately 25% of the population of the membership area, which includes the Portland (Oregon)–Vancouver (Washington) metropolitan area.
KAISER PERMANENTE NORTHWEST
Kaiser
Permanente Northwest (KPNW) serves over 440 000 members, approximately 25% of
the population of the membership area, which includes the Portland
(Oregon)–Vancouver (Washington) metropolitan area (Selby et al., 2005). The distribution of the membership by age, race and
gender proportion-ately reflects that of the population of the Portland–
Vancouver area. Services provided by KPNW include hospital and surgical care,
maternity care, X-rays, mammography, laboratory testing, allergy testing, home
healthcare, doctor office visits, well-baby care, mental health and, unique to
KPNW, dental care. Most of the members are covered by a prepaid drug benefit;
for the less than 10% without the drug bene-fit, prescriptions are provided at
or below prevailing community charges.
Databases
available at KPNW include the Outpa-tient Pharmacy System, which began in 1986
and records all prescriptions dispensed by its outpatient pharmacies. Data
include drug name, NDC code, quantity dispensed, days supplied, refill number,
date and other product information. The automated Inpa-tient Medication System
captures all inpatient medica-tion orders, storing the history of each
hospitalization in a unique hospital stay number that is generated on
admission.
The KPNW also maintains an Adverse and Aller-gic Drug Event
Reporting database, from which it prepares reports for the local KPNW Formulary
and Therapeutics Committee, and submits data to the MedWatch system of the US
Food and Drug Administration (FDA).
Other
data systems include The Inpatient Admis-sion/Discharge/Transfer System, which
provides data on hospitalizations in Kaiser and non-Kaiser hospi-tals, and
includes information on ambulatory surgical and other major procedures
performed in the hospi-tals since the mid-1960s. EpicCare® is an automated
medical record system useful for clinicians providing direct patient care. It
has been used for all outpatient care since 1997, and contains records for more
than 900 000 KPNW members (Selby et al.,
2005). Spin-offs of subsets of these files can make these data accessible for
research purposes.
EpicCare®
has served as the prototype for HealthConnect®, which is currently being
imple-mented across the Kaiser Permanente Program. This new program collects
information not currently collected under a claims-based system, such as orders
for prescriptions (whether or not they were filled) and laboratory tests
(whether or not they were completed), and telephone consults. This information
will allow for studies of adherence to therapy and quality of care and of
safety in large populations (Selby et al.,
2005).
Additional
databases cover the areas of dental care, emergency psychiatric calls and
contacts, emergency department visits, laboratory, cytology and histol-ogy
procedures and results, patient-specific radiol-ogy department data, including
radiology, ultrasound, magnetic resonance imaging, nuclear medicine, and
computerized tomography, prenatal screening, immu-nization, and a continuing
care service database of home care services for homebound members. A Medi-care
Plus II Database contains data from question-naires, distributed annually to
participants, which measure levels of functioning and depression using
standardized instruments.
Multiple
disease registries are maintained by KPNW as well, including cancer, benign
breast disease, breast cancer family registry, diabetes and rheumatology
registries. A genetics registry of more than 5 million members of the Northwest
Division and the Northern and Southern California regions was begun in 1986,
with Hawaii joining this registry in 1992.
The
KPNW Center for Health Research also maintains multiple databases that provide
data on outpatient utilization, information on health status and behaviours of
members, satisfaction with care provided, and other information obtained from
surveys based on a sampling of the KPNW member-ship. The Common Control Pool
database contains basic demographic and eligibility data for virtu-ally all
people who have been members of KPNW. A Pregnancy Registry identifies pregnant
KPNW members, using laboratory data, ultrasound reports and clinic visits,
enabling the tracking of all preg-nancy outcomes. The KPNW immunization
database contributes data to the Vaccine Safety DataLink Project, funded by the
US Center for Disease Control and Prevention (CDC) (see below).
The
KPNW membership mostly reflects the popu-lation of the area it serves, although
again the poor and the very wealthy are under-represented. The membership is
relatively stable after one year; the median length of enrollment retention is
more than 5 years. The use of a unique medical record number allows the linkage
of drug dispensing with inpatient and outpatient files, and it is possible to
calculate prevalence and incidence rates. Access to primary medical records
permits validation of diagnostic infor-mation and gathering of information on
confounding and demographic variables, which, with the excep-tion of age and
gender, are absent from the available databases.
The
Kaiser Permanente formularies are limited, with the newest and/or most
expensive drugs unlikely to be listed. It is also likely that only one brand of
a particular drug is available.
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