Jaewhan Kim - Academia.edu (original) (raw)

Papers by Jaewhan Kim

Journal of Athletic Training, 2019

Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly... more Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly elucidated. Objective To compare structural differences of the knee in those who have sustained an acute first-time patellar dislocation resulting in a medial patellofemoral ligament (MPFL) tear by sex and age (≤17 years old, ≥18 years old). Design Case series. Setting Retrospective magnetic resonance imaging analysis. Patients or Other Participants Thirty-five acute first-time patellar dislocators with an associated MPFL tear. Main Outcome Measure(s) Patellar height using 3 methods, patellar alignment using congruency angles, and trochlear morphology using the sulcus angle. We compared the means of these variables by sex and age. The intraclass correlation coefficient was then calculated to assess the agreement of the independent reviewers. Results A total of 21 left and 14 right knees were analyzed. The MPFL tear location did not differ by sex (P = .34) or age (P = .43). Patellar heig...

New England Journal of Medicine, 2017

BACKGROUND Few long-term or controlled studies of bariatric surgery have been conducted to date. ... more BACKGROUND Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass.

Journal for Healthcare Quality, 2017

To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention... more To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics. A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment. Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP. Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6-12 months after enrollment (OR = 1.70; 95% CI = 1.29-2.25; p &amp;amp;amp;lt; .001) when compared with the no-DPP group. Diabetes Prevention Program-based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.

Journal of Minimally Invasive Gynecology, 2015

The Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) is a postresidency fellowship de... more The Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) is a postresidency fellowship developed with the mission to train the next generation of minimally invasive gynecologic surgeons. The need for surgeons trained in this field has increased, yet there remains a paucity of information regarding the compensation of these specialized surgeons. Design: A survey was sent via e-mail to FMIGS graduates (N 5 221) using an online survey tool; it was sent twice more to increase the response rate between July and December 2013. The survey collected information on current and starting salaries and benefits as well as academic rank, location, practice type, and practice breadth. Comparisons were analyzed using multivariable linear regression models (Canadian Task Force Classification II-2). Setting: E-mail-based survey. Patients: Graduates of the FMIGS. Interventions: A single survey sent 3 times. Measurements and Main Results: Of 221 graduates surveyed, 164 responded (response rate 5 74%). Sixty-one percent of respondents (n 5 100) were from academic institutions, and the remainder were from private practice (n 5 64). Of all respondents, 27 (16.

Value in Health, 2010

Higher MSEs found in indirect mapping were mostly pronounced in lower utilities (<0.2). Predicted... more Higher MSEs found in indirect mapping were mostly pronounced in lower utilities (<0.2). Predicted utilities were slightly higher than actual values when population average was used for input (0.3-3%). Similar fi ndings were noted in sub-samples. CONCLUSIONS: Both methods produced robust results. Compared to direct mapping, indirect mapping better represents the EQ-5D's descriptive information, although with higher MSE/MAE. This research provides algorithms for estimating EQ-5D item responses and utilities on the basis of pain scores in absence of direct utility evidence. Further investigation using out-of-sample predictions is encouraged.

The Annals of Family Medicine, 2013

PURPOSE We examined quality, satisfaction, fi nancial, and productivity outcomes associated with ... more PURPOSE We examined quality, satisfaction, fi nancial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the patient-centered medical home. METHODS We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, fi nancial performance, and effi ciency. RESULTS Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected fi ndings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the effi ciency of visits, with some positive and some negative correlations depending on the outcome. CONCLUSIONS Elements related to care teams and continuity appear to be key elements of CBD as they infl uence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refi ned analyses to identify causal associations.

JAMA Surgery, 2016

IMPORTANCE Bariatric surgery is effective in reducing all-cause and cause-specific long-term mort... more IMPORTANCE Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known. OBJECTIVE To examine whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages. DESIGN, SETTING, AND PARTICIPANTS All-cause and cause-specific mortality rates and hazard ratios (HRs) were estimated from a retrospective cohort within 4 categories defined by age at surgery: younger than 35 years, 35 through 44 years, 45 through 54 years, and 55 through 74 years. Mean follow-up was 7.2 years. Patients undergoing gastric bypass surgery seen at a private surgical practice from January 1, 1984, through December 31, 2002, were studied. Data analysis was performed from June 12, 2013, to September 6, 2015. A cohort of 7925 patients undergoing gastric bypass surgery and 7925 group-matched, severely obese individuals who did not undergo surgery were identified through driver license records. Matching criteria included year of surgery to year of driver license application, sex, 5-year age groups, and 3 body mass index categories. INTERVENTION Roux-en-Y gastric bypass surgery. MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortality compared between those undergoing and not undergoing gastric bypass surgery using HRs. RESULTS Among the 7925 patients who underwent gastric bypass surgery, the mean (SD) age at surgery was 39.5 (10.5) years, and the mean (SD) presurgical body mass index was 45.3 (7.4). Compared with 7925 matched individuals not undergoing surgery, adjusted all-cause mortality after gastric bypass surgery was significantly lower for patients 35 through 44 years old (HR, 0.54; 95% CI, 0.38-0.77), 45 through 54 years old (HR, 0.43; 95% CI, 0.30-0.62), and 55 through 74 years old (HR, 0.50; 95% CI, 0.31-0.79; P < .003 for all) but was not lower for those younger than 35 years (HR, 1.22; 95% CI, 0.82-1.81; P = .34). The lack of mortality benefit in those undergoing gastric bypass surgery at ages younger than 35 years primarily derived from a significantly higher number of externally caused deaths (HR, 2.53; 95% CI, 1.27-5.07; P = .009), particularly among women (HR, 3.08; 95% CI, 1.4-6.7; P = .005). Patients undergoing gastric bypass surgery had a significantly lower age-related increase in mortality than severely obese individuals not undergoing surgery (P = .001). CONCLUSIONS AND RELEVANCE Gastric bypass surgery was associated with improved long-term survival for all patients undergoing surgery at ages older than 35 years, with externally caused deaths only elevated in younger women. Gastric bypass surgery is protective against mortality even for older patients and also reduces the age-related increase in mortality observed in severely obese individuals not undergoing surgery.

Journal of Surgical Research, 2019

Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted ... more Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted further duty hour restrictions in response to concerns over long work hours and sleep deprivation in trainees and their effects on patient outcomes. The effect of duty hour restrictions on complications after breast reconstruction procedures has not been clarified. Materials and methods: A retrospective cross-sectional analysis was designed. The National Inpatient Sample database was queried in the 2 y before and 2 y after the 2011 duty hour changes. Patients undergoing breast reconstruction, the most common elective admission diagnosis for plastic surgery patients, were selected for analysis. Patient groups were separated by teaching hospitals (THs) and nonteaching hospitals and by pre-and post-ACGME change periods. Surgical complication rates, length of stay, and procedures were analyzed using complex survey-weighted univariate and multivariate logistic regression analysis, with additional sensitivity analysis applied. Results: The number of procedures did not vary significantly in the period after duty hour restrictions in THs (n ¼ 46,188, pre-ACGME versus n ¼ 48,980, post-ACGME). Overall complication rates in teaching (9.54%, pre-ACGME versus 9.04%, post-ACGME; P ¼ 0.561) and nonteaching hospitals (8.54%, pre-ACGME versus 7.70%, post-ACGME; P ¼ 0.319) did not significantly change after the implementation of duty hour changes. On multivariate analysis, surgery performed in resident THs after duty hour changes was not associated with a significant change in overall

BMJ Open, 2019

IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary c... more IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation ...

BMJ Open, 2018

IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause... more IntroductionLung cancer is a significant burden on societies worldwide, and the most common cause of death in patients with cancer overall. Exercise intervention studies in patients with lung cancer have consistently shown benefits with respect to physical and emotional functioning. However, to date, exercise training has not been consistently implemented into clinical practice given that interventions have been costly and not aligned with clinical care.Methods/designThe Precision-Exercise-Prescription (PEP) study is a prospective randomised controlled trial comparing the effectiveness and feasibility of a personalised intervention exercise programme among patients with lung cancer undergoing surgery. Two-hundred patients who are diagnosed with stage primary or secondary lung cancer and are eligible to undergo surgical treatment at Huntsman Cancer Institute comprise the target population. Patients are randomised to either the (1) outpatient precision-exercise intervention group or (...

Cancer medicine, Jan 13, 2018

Cancer disparities in rural and frontier communities are an important issue in Utah because much ... more Cancer disparities in rural and frontier communities are an important issue in Utah because much of Utah is sparsely populated. The aims of this study were to investigate whether there are differences in the cancer incidence and 5-year survival rates in Utah by metropolitan/rural residence and to investigate disparities in distributions of cancer risk factors. We used cancer registry records to identify patients diagnosed with a first primary cancer in Utah between 2004 and 2008. We estimated 5-year survival and incidence rates. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for the risk of death. There were 32,498 (86.9%) patients with cancer who lived in metropolitan counties and 4906 (13.1%) patients with cancer who lived in rural counties at the time of cancer diagnosis. Patients with cancer from rural counties were more likely to be older, American Indian/Alaskan Native, non-Hispanic, male, and diagnosed at higher stage. Rural residents had a five-y...

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Dec 1, 2017

Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a ... more Background: Thyroid cancer is the most rapidly increasing cancer in the United States, affects a young population, has high survival, and is one of the most common cancers in people under age 40. The aim of this study was to examine the risks of aging-related diseases in a statewide sample of thyroid cancer survivors who were diagnosed <40 years compared with those diagnosed ≥40 and a cancer-free sample.Methods: Thyroid cancer survivors diagnosed 1997 to 2012 were matched to up to 5 cancer-free individuals on birth year, sex, birth state, using the statewide Utah Population Database. Medical records were used to identify disease diagnoses stratified over three time periods: 1 to 5, >5 to 10, and 10+ years after cancer diagnosis. Cox proportional hazards models were used to estimate hazard ratios with adjustment on matching factors, race, body mass index, and Charlson Comorbidity Index.Results: There were 3,706 thyroid cancer survivors and 15,587 matched cancer-free individuals...

Preventing chronic disease, Jul 20, 2017

Evaluation of interventions can help to close the gap between research and practice but seldom ta... more Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP). Adult patients who met the criteria for prediabetes (HbA1c of 5.70%-6.49% or fasting plasma glucose of 100-125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance. Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4...

PloS one, 2016

To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and uncon... more To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and unconfirmed prediabetes (preDM) relative to an at-risk group receiving care from primary care physicians over a 5-year period. Utilizing data from the Intermountain Healthcare (IH) Enterprise Data Warehouse (EDW) from 2006-2013, we performed a prospective analysis using discrete survival analysis to estimate the time to diagnosis of T2DM among groups. Adult patients who had at least one outpatient visit with a primary care physician during 2006-2008 at an IH clinic and subsequent visits through 2013. Patients were included for the study if they were (a) at-risk for diabetes (BMI ≥ 25 kg/m2 and one additional risk factor: high risk ethnicity, first degree relative with diabetes, elevated triglycerides or blood pressure, low HDL, diagnosis of gestational diabetes or polycystic ovarian syndrome, or birth of a baby weighing >9 lbs); or (b) confirmed preDM (HbA1c ≥ 5.7-6.49% or fasting blood gl...

The Annals of Family Medicine, 2015

The Laryngoscope, Jan 26, 2015

To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outp... more To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders. Retrospective analysis of a large, national, administrative US claims database. The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment. There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voi...

Physical therapy, Jan 27, 2015

Medicaid insures an increasing proportion of adults in the United States. Physical therapy utiliz... more Medicaid insures an increasing proportion of adults in the United States. Physical therapy utilization for LBP in this population has not been described. Examine physical therapy utilization for Medicaid enrollees with new LBP consultations and evaluate associations with future healthcare utilization and LBP-related costs. Retrospective evaluation of claims data METHODS: We identified 2,289 individuals with new LBP consultations during 2012 (age = 39.3 years (+11.9), 68.2% female). The setting in which the patient entered care was and co-morbid conditions were identified. We examined a year after entry and categorized physical therapy utilization as 1) entry setting, 2) early (within 14 days of entry), or 3) delayed (>14 days after entry). We evaluated the year follow-up period for utilization outcomes (imaging, injections, surgery, emergency department (ED) visit) and LBP-related costs . Variables associated with physical therapy, utilization and cost outcomes were evaluated usi...

The Laryngoscope, Jan 17, 2015

To determine the type, frequency, and factors associated with voice disorders in the elderly. Ret... more To determine the type, frequency, and factors associated with voice disorders in the elderly. Retrospective analysis of data from a large national administrative US claims database. Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses. Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65-105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosi...

ISRN cardiology, 2011

Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiov... more Objective. To determine whether increases in heart rates (HRs) over time leads to adverse cardiovascular (CV) events among "healthy subjects." Methods. This retrospective cohort study used the GE Centricity EMR database. "Healthy subjects" were defined as those with Charlson Comorbidity Index (CCI) score = 0 and Chronic Disease Score (CDS) = 0 at baseline. Subjects were followed for 3 years post the first date of a clinical encounter between the patient and provider. Those aged ≥18 years old with baseline HR and ≥2 post-index HR readings were identified between 01/01/1996 to 03/30/2007. Results. There were 93,952 "healthy subjects" at baseline (median age 42 years; 67.2% women; mean HR was 75.8 (SD: 11) bpm); 20.7% with a mean HR at baseline of 76.3 (SD: 11.3) bpm (median age 45; 63 women) experienced a CV event during 3 years of follow-up. The mean HR was higher among those with a CV event (76.3 bmp) compared to those without a CV event (75.7 bpm). A C...

The Laryngoscope, Jan 13, 2015

We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosi... more We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosis and treatment in patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative U.S. claims database. Patients included were identified with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, from January 1, 2004, to December 31, 2008, and had been seen by an otolaryngologist as an outpatient and had a specialty voice evaluation designated by videolaryngostroboscopy (VLS) within 90 days of the last laryngoscopy. Patient diagnosis at the last laryngoscopy visit and the subsequent initial VLS visit were collected. Specific treatment modalities were tabulated for the 30-day period after the last laryngoscopy and for 30 days after the VLS. A total of 168,444 unique patients saw an otolaryngologist for 273,616 outpatient visits. Of those, 6.1% had a VLS performed, of which 4,000 (23.8%) oc...