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Winter 2013/ Volume 17 No. 1

ON THE COVER “Aspens at Kenosha Pass” by Brad Christian McDowell, MD, was taken at an aspen grove in Kenosha Pass, a prime area to view fall colors in Colorado.

Dr McDowell is a Plastic Surgeon at the Denver Medical Office. He has been an amateur photographer since college and prefers landscape, street, and travel photography.

ORIGINAL RESEARCH & CONTRIBUTIONS 4 Neighborhood-Level Hot Spot Maps to

Inform Delivery of Primary Care and Allocation of Social Resources. Nancy S Hardt, MD; Shehzad Muhamed; Rajeeb Das, MSPH; Roland Estrella, BSCE; Jeffrey Roth, PhD

The University of Florida Family Data Center created “hot spot” density maps of impor-tant health and social indicators to highlight the location of disparities at the neigh-borhood level. Data sharing resulted in advocacy efforts to build a family resource center and to implement a mobile clinic.

11 Ingestion of Magnetic Toys: Report of Serious Complications Requiring Surgical Intervention and a Proposed Management Algorithm. Jerry Tsai, MD; Donald B Shaul, MD; Roman M Sydorak, MD; Stanley T Lau, MD; Yasir Akmal, MD; Karen Rodriguez, RN, MN, CPNP-PC/AC

Increasing popularity of magnets as toys has led to their ingestion by children. A retrospective review of magnet ingestions treated over a 2-year period included 5 patients who presented with abdominal symptoms. Four of the 5 patients suffered serious complications, including bowel necrosis, perforation, fistula formation, and obstruction. All patients were successfully treated with laparoscopic-assisted explora-tion with or without endoscopy.

16 Effects and Linguistic Analysis of Writ-ten Traumatic Emotional Disclosure in an Eating-Disordered Population.Ashli M Gamber, MD; Susan Lane-Loney, PhD; Martha Peaslee Levine, MD

Writing about traumatic life events pro-duced positive physical and psychological outcomes in various populations. Par-ticipants included 29 female patients from the Penn State Hershey Eating Disorders partial-hospitalization program. Individuals completing the disclosure writing used more negative emotion, insight, cognitive, func-tion, and filler words along with decrease of tentative words. No correlating health benefits could be found. Eating-disordered populations, often alexithymic, may have difficulty engaging with the disclosure task.

21 Operational Challenges in Delivery of a Charity Care Program for Diabetic Retinopathy Screening in an Urban Setting. Erica H Chedid, AM; Quin R Golden, MBA; Rama D Jager, MD, MBA, FACS

University of Chicago Medicine partnered with Chicago Family Health Center to screen uninsured and underinsured patients for dia-betic retinopathy. They recalled patients with ungradable images for repeat imaging, had regular staff training, sent weekly e-mails to the physician champion to read images, sent reminder cards, and made preappointment and postappointment phone calls. The over-all number of ungradable images decreased and show rates began to increase.

26 Improving Efficiency and Reducing Administrative Burden through Electronic Communication. Katlyn E Cook; Gail M Ludens; Amit K Ghosh, MD; William C Mundell, MD; Kevin C Fleming, MD; Andrew J Majka, MD

A standardized InBox was implemented at Mayo Clinic Division of General Internal Medicine. Sixteen of 28 individuals (57%) completed the preintervention survey. Twenty-eight clinicians participated in 2 separate 8-day pilot tests. The number of Inbox defects was substantially reduced from 37 to 7. Frequent InBox defects decreased from 25% to 10%. More than half of clinicians believed the standardized InBox positively affected their work and 100% reported no negative effect.

31 Quality and Cost Evaluation of a Medical Financial Assistance Program. Douglas A Conner, PhD; Arne Beck, PhD; Christina Clarke; Leslie Wright, MA; Komal Narwaney, MD, PhD; Neysa W Bermingham

A prospective cohort study of 308 medical financial assistance (MFA) program mem-bers were enrolled between May 2008, and May 2009. Use of services was analyzed with multiple regression, and costs of ser-vices with generalized linear models. MFA increased members’ access to health services. Hospital costs were lower, but costs for clinic visits, pharmacy services, phone calls, and radiology services were significantly higher.

38 Breast Cancer Screening in an Insured Population: Whom Are We Missing? Karin L Kempe, MD, MPH; Rebecca Sam Larson, PhD; Susan Shetterley; Andra Wilkinson

The authors retrospectively evaluated data from 47,946 women aged 52 to 69 years who had not undergone mammography. Nonwhite ethnicity increased risk of screen-ing failure if black, Latina, “other,” or miss-ing race/ethnicity. A greater number of of-fice visits in any setting was associated with greater likelihood of undergoing mammog-raphy. Increasing screening among women with missing race/ethnicity data, could improve mammography screening rates.

Implementation Study 45 The Banner Psychiatric Center: A

Model for Providing Psychiatric Crisis Care to the Community while Easing Behavioral Health Holds in Emergency Departments. Pat Little-Upah, MA; Chris Carson, MD; Robert Williamson, MD; Tom Williams, MC; Michael Cimino, MBA; Neena Mehta, MSN; Jeff Buehrle, MBA; Steve Kisiel, MSIE

Banner Health, in Phoenix, AZ, provides individuals in a behavioral health crisis with an alternative to presenting to an Emergency Department (ED). By quickly moving patients out of the ED, their hold time was greatly reduced. The center provides access to psychiatric clinicians around the clock. Finally, disposition of patients into appropriate levels of care has freed up acute care Level 1 beds.

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The Permanente Journal/ Winter 2013/ Volume 17 No. 1

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Thank you to our 2012 reviewers:Antoine Abcar, MD; Armen Aboulian, MD; Richard Abrohams, MD; Michael Alberts, MD; Claudia Alleyne, MD; Andrew Altman, MD; Pamela Anderson, MD; James Annesi, PhD; Joseph Armao, MD; Stanley Ashley, MD; Keith Bachman, MD; David Baer, MD; Mike Baiocchi, MD; Nandini Bakshi, MD; Katherine Balazy, MD; Carole Bartolotto; Deborah Bassett, PhD; Arne Beck, PhD; Kathy Benjamin, RN; Jane Benton, MD; Randy Bergen, MD; Mibhali Bhalala, MD; Solomon Bitew, MD; Shelley Bobb; Teri Bordenave, MHSA; Gabriel Bosslet, MD, MA; Robert Bota, MD; Jeffrey Braff, DrPH; Radhika Breaden, MD; Gayne Brenneman, MD; Kimberly Brown, MSOM, LAc; Austin Brown; Brian Budenholzer, MD; Kenneth Burns, MD; Maurice Cates, MD; Gail Cavallo, NP; David Cawthorpe, PhD; David Chadwick, MD; Rebecca Chasnovitz, MD; John Chen, MD; Joseph Chen, MD; Ricky Chen, MD Candidate; Stephen Cheng, MD; Gary Chien, MD; Jaeun Choi, PhD; Marilyn Chow, DNSc; Reema Chugh, MD; Robert Cima, MD, FACS, FASCRS; David Clarke, MD; David Ed Clarke, MD; Charles Clemons, MD; Amy L Compton-Phillips, MD; Douglas Conner, PhD; Lydia Cook, MD; Ellen Cosgrove, MD; James Cotter, MD, MPH; Alberto Coustasse, PhD; Barbara Crawford, RN; Claudio Crisci, MD; Thomas Dailey, MD; Dale Daniel, MD; Carrie Davino-Ramaya, MD; Richard Davis, MD; Jack Der-Sarkissian, MD; Jennifer DeVoe, MD; Mark Di Corcia, MD; Jeffrey Du Bois, MD; Ashley Duggan, PhD; Andrew Dutka, MD; Amy Eakin; Erica Eckhardt, AM; Quentin Eichbaum, MD, PhD, MPH, MFA; Donna Ettel, PhD; Alan Evans, MD; Kathryn Evers, MD; Ted Eytan, MD; Douglas Faries, PhD; Shireen Fatemi, MD; Vincent Felitti, MD; Kristi Ferguson, PhD; Andrew Fong, MD; Carol Forster, MD; Erina Foster, MD; Kristina Franco, Sandra Freiwald, MD; Lori Friedman; Cari Friesleben, MD; Pascal Fuchshuber, MD; Peter Fung, MD; Vicki Fung, PhD; Gordon Garcia, MD; Michael Garland, MD; Timothy Garling, PA-C; Terhilda Garrido, MPH; Jay (James) Gehrig, MD; Martin Gilboa, MD; Lana Gimber, MD, MPH; Louise Glaser, MD; Paul Glen, MD; Daniel Glor, MD; Alan Go, MD; Geoff Gordon, MD; Richard Green, MD; Sarah Greene, MPH; Casey Grover, MD; Eliot Gutow, LISW; Nicolas Gwozdziewycz; James T Hardee, MD; Jeffrey S Har-ris, MD; Paul Hartman, MD; Arthur Hayward, MD; Christopher Hebert, MD; Deborah Hedges; Lisa Heikoff, MD; Ann Hellerstein, MD; Catherine Hickie, MBBS; Jacqueline Hill, MPH; James Hipkens, MD; Cheryl Ho, MD; Angie Hochhalter, MD; Dieter Hoffmann, MD; Robert Hogan, MD; Raymond Hong, MD, MBA; Gary Huffaker, MD; Robert Hughes, MD; Robert J Hye, MD; Talha Imam, MD; Shoreh Irani, MD; Mohamed Ismail, MD, MPH; Eijun Itakura, MD, PhD; Steven Jacobsen, MD; Laura Janisse; Monica Jarrell, NP; Samir Johna, MD; Thomas Judd, MS; Renate G Justin, MD; Michael Kaplan, MD; Saul Kaplan, MD; Laura Kerr, PhD, IMFT; Kamal M Khalid, MD; Afshin Khatibi, MD; Minh Kim, MD; Anna Kirkengen, MD; Daniel Klaristenfeld, MD; Betty Lou Koffel, MD; Susan Korn, MSHSA; Mike Kositch, MD; Thomas Kottke, MD, MSPH; Michael Krall, MD; David Kwon, MD; Myles Lampenfeld, MD; Mary Lane-Carlson, EdD, MPH, RD, CDE; Kenneth Larsen, MD; John Lasater, MD; Eric Lee, MD; Doohee Lee, PhD; Lonnie Lee, MD; David Lerman, MD; Martha Levine, MD; Joel Levis, MD, PhD; Evelyn Lifsey, PhD; James Lin, MD; James Lindeen, MD; Rasjad Lints, MD; Waleed Lutfiyya, MD; John Maa, MD; Barbara Mainguy; Abir Makarem, PharmD; M. 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