Kaiser Permanente Northwest

Kaiser Permanente Northwest (KPNW) serves over 430 000 members, approximately 25% of the population of the area (Friedman et al., 2000), mostly in the outpatient setting, with one hospital in Portland and beds contracted in other community hospitals. The distribution of the membership by age, race, and gender proportionately reflects that of the population of the Portland-Vancouver area. Services provided by KPNW include hospital and surgical care, maternity care, X-rays, mam-mography, laboratory testing, allergy testing, home healthcare, doctor office visits, well-baby care, mental health, and dental care. Most of the members are covered by a prepaid drug benefit; for the less than 10% without the drug benefit, prescriptions are provided at or below prevailing community charges.

Databases available at KPNW include the Outpatient Pharmacy System, which began in

1986 and records all prescriptions dispensed by its outpatient pharmacies, totaling more than two million annually (Friedman et al., 2000). Data include National Drug Code (NDC) number, quantity dispersed, days supplied, refill number, date, and other product information. The automated Inpatient Medication System captures all inpatient medication orders, storing the history of each hospitalization in a unique hospital stay number that is generated on admission.

KPNW also maintains an Adverse and Allergic 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 Admission/Discharge/Transfer System, which provides data on hospitalizations in Kaiser and non-Kaiser hospitals, and includes information on ambulatory surgical and other major procedures performed in the hospitals since the mid-1960s. EpicCare is an automated clinical information system useful for clinicians providing direct patient care. Spin-offs of subsets of these files can make these data accessible for research purposes.

Additional databases cover the areas of dental care, emergency psychiatric calls and contacts, emergency department visits, laboratory, cytology and histology procedures and results, patient-specific radiology department data, including radiology, ultrasound, magnetic resonance imaging, nuclear medicine, and computerized tomography, prenatal screening, immunization, and a continuing care service database of home care services for homebound members. A Medicare Plus II Database contains data from questionnaires, distributed annually to participants, which measure with standardized instruments levels of functioning and depression.

Multiple disease registries are maintained by KPNW as well, including cancer, benign breast disease, breast cancer family registry, diabetes, and rheumatology registries. Results of cytogenetic testing of more than 5 million members of the Northwest Division and the Northern and Southern California regions are available from 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 behaviors of members, satisfaction with care provided, and other information obtained from surveys based on a sampling of the KPNW membership. The Common Control Pool database contains basic demographic and eligibility data for virtually 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 pregnancy outcomes.

The KPNW membership mostly reflects the population 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 five 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 information and gathering of information on confounding and demographic variables, which, with the exception 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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