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Objective: To determine if patient gender and race affect decisions about pain management.Design, Setting, and Participants: Experimental design using medical vignettes to evaluate treatment decisions. A convenience sample of 111 primary care physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypothetical patients with pain (kidney stone, back pain) or a control condition (sinusitis). Symptom presentation and severity were held constant, but patient gender and race were varied.Measurements and Main Results: The maximum permitted doses of narcotic analgesics (hydrocodone) prescribed at initial and return visits were calculated by multiplying mg per pill x number of pills per day x number of days x number of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses. However, for renal colic, male physicians prescribed higher doses of hydrocodone to white patients versus black patients (426 mg vs 238 mg), while female physicians prescribed higher doses to blacks (335 mg vs 161 mg, F1,85 = 9.65, P =.003). This pattern was repeated for persistent kidney stone pain. For persistent back pain, male physicians prescribed higher doses of hydrocodone to males than to females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg v. 163 mg, F1,28 = 5.50, P =.03).Conclusion: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male and female physicians may react differently to gender and/or racial cues. [ABSTRACT FROM AUTHOR]

Stakeholders in the clinical research enterprise are aligned around the need to make clinical research in general, and randomized controlled trials in particular, more meaningful and efficient. To that end, we have built distributed research networks (DRNs) for the Sentinel System, the National Institutes of Health (NIH) Collaboratory, and the National Patient-Centered Clinical Research Network (PCORnet). DRNs reuse electronic health record (EHR) and claims data for research. The design and use of health data DRNs is complicated by lack of uniformity in data collection, a fragmented healthcare system, and the imperative to protect research participants. We describe the key elements of successful DRNs, as well as methods, challenges, and solutions we have encountered in using DRNs to support different phases of randomized, multi-site, clinical research. This work supports "real-world" efforts to build a learning health system and will enable others to conduct randomized clinical trial research using a DRN., Competing Interests: This work is supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director. The views presented here are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. JB, BH and RP have no conflicts of interest to disclose; BS reports grants from NIH during the conduct of the study; KM reports grants from PCORI, during the conduct of the study; personal fees from Novartis, outside the submitted work; AH reports grants and personal fees from AstraZeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from American Regent, grants and personal fees from Novartis, grants and personal fees from Merck, grants from Verily, outside the submitted work; LC reports grants from GlaxoSmithKline, grants from Novartis, grants from Boston Scientific, from St. Jude, outside the submitted work; SR reports grants from GSK, outside the submitted work. There are no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work., (© 2019 Published by Elsevier Inc.)

Background: Data from randomized controlled trials and observational studies on older adults who take statins for primary prevention of atherosclerotic cardiovascular disease are limited. To determine the incidence of statin use in older adults with and without cardiovascular disease (CVD) and/or diabetes (DM), we conducted a descriptive observational study., Methods: The cohort consisted of health plan members in the NIH Collaboratory Distributed Research Network aged >75 years who had continuous drug and medical benefits for ≥183 days during the study period, January 1, 2008- March 31, 2018. We defined DM and CVD using diagnosis codes, and identified statins using dispensing data. Statin use was considered incident if a member had no evidence of statin exposure in the claims during the previous 183 days, and the use was considered long-term if statins were supplied for ≥180 days. Incidence rates were reported among members with and without CVD and/or diabetes, and stratified by year, sex, and age group., Results: Among 757,569 eligible members, 109,306 older adults initiated statins and 54,624 became long-term users. Health plan members with CVD had the highest incidence of statin use (143.9 initiators per 1,000 member-years for CVD & DM; 114.5 initiators per 1,000 member-years for CVD & No DM). Among health plan members without CVD, those with DM had rates of statin use that were over two times higher than members without DM (76.1 versus 34.5 initiators per 1,000 member-years, respectively). Statin initiation remained steady throughout 2008-2016, was slightly higher in males, and declined with increasing age., Conclusion: Incidence of statin use varied by CVD and DM comorbidity, and was lowest among those without CVD. These results highlight the potential clinical equipoise to conduct large pragmatic clinical trials to generate evidence that could be used to inform future blood cholesterol guidelines., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: One of the authors [KH] is employed by HealthCore, Inc. Dr. Curtis has research contracts with Glaxo Smith Kline, Medtronic, and Novartis. None of the work is related to this manuscript. Dr. Hernandez consults and conducts research for AstraZeneca, Merck, and Novartis. He consults for Bayer. The other authors have declared that no competing interests exist. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Purpose: To evaluate the validity of health plan administrative and claims data to identify pre-gestational and gestational diabetes, obesity, and ultrasounds among pregnant women., Methods: A retrospective study was conducted using the administrative and claims data of three health plans participating in the HMO Research Network. Diagnoses, drug dispensings, and procedure codes were used to identify diabetes, obesity, and ultrasounds among women who were pregnant between January 2006 and December 2008. A random sample of medical charts (n = 222) were abstracted. Positive predictive values (PPVs) were calculated. Sensitivity also was calculated for obesity among women for whom body mass index data were available in electronic medical records at two sites., Results: Overall, 190 of 222 cases of diabetes (86%) were confirmed (82% for gestational diabetes and 74% for pre-gestational diabetes). The PPV for codes to identify ultrasounds was 80%. Whereas the PPV for obesity-related diagnosis codes was high (93%), and the sensitivity was low (33%)., Conclusions: Health plan administrative and claims data can be used to accurately identify pre-gestational and gestational diabetes and ultrasounds. Obesity is not consistently coded., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objective: To determine if patient gender and race affect decisions about pain management., Design, Setting, and Participants: Experimental design using medical vignettes to evaluate treatment decisions. A convenience sample of 111 primary care physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypothetical patients with pain (kidney stone, back pain) or a control condition (sinusitis). Symptom presentation and severity were held constant, but patient gender and race were varied., Measurements and Main Results: The maximum permitted doses of narcotic analgesics (hydrocodone) prescribed at initial and return visits were calculated by multiplying mg per pill x number of pills per day x number of days x number of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses. However, for renal colic, male physicians prescribed higher doses of hydrocodone to white patients versus black patients (426 mg vs 238 mg), while female physicians prescribed higher doses to blacks (335 mg vs 161 mg, F1,85 = 9.65, P =.003). This pattern was repeated for persistent kidney stone pain. For persistent back pain, male physicians prescribed higher doses of hydrocodone to males than to females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg v. 163 mg, F1,28 = 5.50, P =.03)., Conclusion: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male and female physicians may react differently to gender and/or racial cues.