A care coordination program to support patients with hepatitis B virus at Kaiser Permanente Mid-Atlantic States.

BACKGROUND: Eliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B. METHODS: Here, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer). This study describes the HBV Pathway steps and reports sociodemographic factors of patients by initiation and completion. RESULTS: Results showed a 72.5% completion rate (defined as completing all Pathway steps including the final specialty visit) among patients who initiated the Pathway. Differences in completion were observed by age, race, ethnicity, and service area, with higher rates for younger ages, Asian race, non-Hispanic ethnicity, and lower rates for patients within one service area. Of those who completed the specialty visit, 59.5% were referred for hepatocellular carcinoma surveillance. CONCLUSIONS: The HBV Pathway offers dual benefits- care coordination support for patients to promote Pathway completion and a standardized testing and referral program to reduce physician burden. This program provides an easy and reliable process for patients and physicians to obtain updated clinical information and initiate treatment and/or liver cancer screening if needed.

Niveles diurnos de progesterona en mujeres con ciclos normales / Serum progesterone levels from women with regular cycles

En 20 mujeres sin trastornos menstruales y con evidencia ultrasonográfica de ovulación, se cuantificaron los niveles de progesterona durante la mañana (9:00-11:00) y la tarde (2:00-4:00) de un día correspondiente a las fases lútea temprana, mediana y tardía. Los niveles de progesterona obtenidos en la mañana no fueron estadísticamente diferentes de los valores obtenidos en la tarde en ninguno de los días estudiados. Las fluctuaciones en los niveles de progesterona observadas durante las fases lútea temprana, media y tardía fueron relativamente pequeñas y durante la fase lútea media en ninguna de las mujeres estudiadas se obtuvieron valores de progesterona inferiores a 5 ng/ml. Por lo tanto, concluimos que una sola determinación de progesterona, realizada en la fase lútea media del ciclo y durante el intervalo comprendido entre las 9:00 a.m y las 4:00 p.m, es suficientemente para evaluar adecuadamente la función del cuerpo lúteo