Bio

Dr. Colette DeJong is general cardiologist and health services researcher at Stanford University and the VA Palo Alto. A graduate of Brown University and the University of California, San Francisco School of Medicine, Dr. DeJong completed an internal medicine residency, chief residency, and fellowship in cardiovascular medicine at UCSF, as well as a two-year editorial fellowship at JAMA Internal Medicine and a research fellowship at the UCSF Center for Healthcare Value. Dr. DeJong’s research focuses on improving access to effective cardiovascular therapies. She is interested in developing and evaluating novel strategies to improve care delivery, such as cardiovascular combination pills (“polypills”). Dr. DeJong served as the principal investigator of a pilot clinical trial of heart failure polypills at Zuckerberg San Francisco General Hospital.

Clinical Focus

  • Cardiovascular Disease

Academic Appointments

Honors & Awards

  • ACC/ABC Merck Research Fellowship Award, American College of Cardiology and Association of Black Cardiologists (2023)
  • Housestaff Teaching Award for the Division of Cardiology, UCSF Division of Cardiology (2022)
  • Daniel Ford Award (national award for health services and outcomes research by a medicine resident), Johns Hopkins Division of General Internal Medicine (2018)
  • UCSF Gold-Headed Cane Society, UCSF School of Medicine (2017)
  • Dean's Prize, UCSF School of Medicine (2017)
  • Winner, National Medical Student Abstract Competition, American College of Physicians (2016)

Boards, Advisory Committees, Professional Organizations

  • Board of Trustees, UCSF Gold-Headed Cane Society (2023 - Present)

Professional Education

  • Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2024)
  • Fellowship: UCSF Dept of Cardiology (2024) CA
  • Chief Residency, University of California San Francisco (2021)
  • Residency: University of California San Francisco Internal Medicine Residency (2021) CA
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2020)
  • Medical Education: University of California at San Francisco School of Medicine (2017) CA

Contact

  • Clinical (Primary)  Medicine 300 Pasteur Dr Rm JC007 Stanford, CA 94305 (650) 725-8381 (fax)

Additional Clinical Info

Additional Info

Clinical Trials

  • Heart Failure Polypill at a Safety Net Hospital Not Recruiting

    A novel four-drug regimen for heart failure with reduced ejection fraction (HFrEF) extends patients' life expectancy by an average of 6 years compared to traditional therapies, in addition to improving quality of life. Unfortunately, uptake of this complex multi-drug regimen has been low, especially among underserved communities with barriers to medication adherence. Although combination tablets have transformed access to care for conditions such as HIV and tuberculosis, no combination pill is available for HFrEF. In the proposed study, the investigators will utilize inexpensive over-encapsulation techniques to develop a novel combination pill ("polypill") for patients with HFrEF. In Aim 1, the investigators will conduct stakeholder interviews with patients, providers, and pharmacists to inform the design of a HFrEF polypill. In Aim 2, the investigators will conduct a pilot, single-center, crossover randomized clinical trial to investigate whether, compared to usual care, a HFrEF polypill increases medication adherence among 20-40 adults with HFrEF. Given the high daily pill burden among patients with HIV and HFrEF, the investigators aim to recruit a subgroup of patients with HIV (\~10-20 participants) in addition to a subgroup of patients without HIV (\~10-20 participants).

    Stanford is currently not accepting patients for this trial.

    View full details

All Publications

  • New and future heart failure drugs. Nature cardiovascular research Haghighat, L., DeJong, C., Teerlink, J. R. 2024

    Abstract

    In the past decade, our understanding of heart failure pathophysiology has advanced significantly, resulting in the development of new medications such as angiotensin-neprilysin inhibitors, sodium-glucose cotransporter-2 inhibitors and oral soluble guanylate cyclase stimulators. Backed by positive findings from large randomized controlled trials, recommendations for their use were recently included in the 2022 AHA/ACC/HFSA guidelines and 2023 ESC guidelines for management of heart failure. Promising drugs for future heart failure treatment include agents that modulate the neurohormonal system, vasodilators, anti-inflammatory drugs, mitotropes, which improve deranged energy metabolism of the failing heart, and myotropes, which increase cardiac contractility by affecting cardiac sarcomere function. Here, we discuss these new and future heart failure drugs. We explain their mechanisms of action, critically evaluate their performance in clinical trials and summarize the clinical scenarios in which the latest guidelines recommend their use. This Review aims to offer clinicians and researchers a comprehensive overview of novel therapeutic classes in heart failure treatment.

    View details for DOI 10.1038/s44161-024-00576-z

    View details for PubMedID 39632985

    View details for PubMedCentralID 5811193

  • Stakeholder Perspectives on a Heart Failure With Reduced Ejection Fraction Polypill: A Multi-Center Mixed Methods Study. Circulation. Cardiovascular quality and outcomes Chen, J. C., DeJong, C., Agarwal, M., Hairston, A. M., Durstenfeld, M. S., McKay, V., Huffman, M. D., Hsue, P. Y., Agarwal, A. 2024: e011121

    Abstract

    A polypill containing all 4 classes of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) has been proposed to change the heart failure treatment paradigm. The acceptability, appropriateness, and feasibility of a HFrEF polypill-based strategy are unknown. The purpose of this study was to elicit patients' and providers' priorities in the design of HFrEF polypills.From April 2023 to December 2023, we conducted a convergent parallel mixed-methods study at Washington University in St. Louis, the University of California, San Francisco, and the American College of Cardiology. We administered physician surveys containing adapted implementation outcome measures to elicit physicians' perspectives on the acceptability, feasibility, and appropriateness of a HFrEF polypill (Likert scale ranging from 1 [low] to 5 [high]). We used a purposive sampling frame to select patients and physicians for in-depth interviews. Using semi-structured interview guides, we elicited participants' perspectives on current HFrEF care, HFrEF polypill design, and supportive strategies. The Consolidated Framework for Implementation Research v2.0 guided thematic analysis.Of the 214 survey respondents across the United States, physicians agreed that HFrEF polypills are highly acceptable (mean [SD], 4.2 [0.7]), highly appropriate (4.1 [0.8]), and highly feasible (4.1 [0.7]). Key themes from 9 patient and 22 provider interviews included the following: (1) current determinants of HFrEF care, including medication adherence, variations in clinical practice, and health care access, (2) provider-level differences in preferred HFrEF polypill design, (3) cost and equity considerations in the implementation of HFrEF polypills, and (4) research priorities for evaluating polypill effectiveness and implementation.A HFrEF polypill-based strategy was viewed as highly acceptable, appropriate, and feasible by patients and physicians. Participants described key priorities in HFrEF polypill design, titratability, and potential impacts on health equity that will directly inform future randomized controlled trials.

    View details for DOI 10.1161/CIRCOUTCOMES.124.011121

    View details for PubMedID 39503613

  • Heart failure with preserved ejection fraction NATURE REVIEWS DISEASE PRIMERS Hamo, C. E., DeJong, C., Hartshorne-Evans, N., Lund, L. H., Shah, S. J., Solomon, S., Lam, C. P. 2024; 10 (1): 55

    Abstract

    Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and has a prevalence that is expected to rise with the growing ageing population. HFpEF is associated with significant morbidity and mortality. Specific HFpEF risk factors include age, diabetes, hypertension, obesity and atrial fibrillation. Haemodynamic contributions to HFpEF include changes in left ventricular structure, diastolic and systolic dysfunction, left atrial myopathy, pulmonary hypertension, right ventricular dysfunction, chronotropic incompetence, and vascular dysfunction. Inflammation, fibrosis, impaired nitric oxide signalling, sarcomere dysfunction, and mitochondrial and metabolic defects contribute to the cellular and molecular changes observed in HFpEF. HFpEF impacts multiple organ systems beyond the heart, including the skeletal muscle, peripheral vasculature, lungs, kidneys and brain. The diagnosis of HFpEF can be made in individuals with signs and symptoms of heart failure with abnormality in natriuretic peptide levels or evidence of cardiopulmonary congestion, facilitated by the use of HFpEF risk scores and additional imaging and testing with the exclusion of HFpEF mimics. Management includes initiation of guideline-directed medical therapy and management of comorbidities. Given the significant impact of HFpEF on quality of life, future research efforts should include a particular focus on how patients can live better with this disease.

    View details for DOI 10.1038/s41572-024-00540-y

    View details for Web of Science ID 001291681600001

    View details for PubMedID 39143132

    View details for PubMedCentralID 10680134

  • DIRECT-TO-PHYSICIAN MARKETING AND ADOPTION OF GUIDELINE-DIRECTED MEDICAL THERAPY IN MEDICARE PART D DeJong, C., Inoue, K., Durstenfeld, M., Agarwal, A., Chen, J. C., Tseng, C., Dudley, R., Hsue, P. Y., Kazi, D. ELSEVIER SCIENCE INC. 2024: 611

    View details for Web of Science ID 001324901500612

  • The Inflation Reduction Act and Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Disease JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Kazi, D. S., DeJong, C., Chen, R., Wadhera, R. K., Tseng, C. 2023; 81 (21): 2103-2111

    Abstract

    High out-of-pocket costs can impede access to guideline-directed cardiovascular drugs. The 2022 Inflation Reduction Act (IRA) will eliminate catastrophic coinsurance and cap annual out-of-pocket costs for Medicare Part D patients by 2025.This study sought to estimate the IRA's impact on out-of-pocket costs for Part D beneficiaries with cardiovascular disease.The investigators chose 4 cardiovascular conditions that frequently require high-cost guideline-recommended drugs: severe hypercholesterolemia; heart failure with reduced ejection fraction (HFrEF); HFrEF with atrial fibrillation (AF); and cardiac transthyretin amyloidosis. This study included 4,137 Part D plans nationwide and compared projected annual out-of-pocket drug costs for each condition in 2022 (baseline), 2023 (rollout), 2024 (5% catastrophic coinsurance eliminated), and 2025 ($2,000 cap on out-of-pocket costs).In 2022, mean projected annual out-of-pocket costs were $1,629 for severe hypercholesterolemia, $2,758 for HFrEF, $3,259 for HFrEF with AF, and $14,978 for amyloidosis. In 2023, the initial IRA rollout will not significantly change out-of-pocket costs for the 4 conditions. In 2024, elimination of 5% catastrophic coinsurance will lower out-of-pocket costs for the 2 costliest conditions: HFrEF with AF ($2,855, 12% reduction) and amyloidosis ($3,468, 77% reduction). By 2025, the $2,000 cap will lower out-of-pocket costs for all 4 conditions to $1,491 for hypercholesterolemia (8% reduction), $1,954 for HFrEF (29% reduction), $2,000 for HFrEF with AF (39% reduction), and $2,000 for cardiac transthyretin amyloidosis (87% reduction).The IRA will reduce Medicare beneficiaries' out-of-pocket drug costs for the selected cardiovascular conditions by 8% to 87%. Future studies should assess the IRA's impact on adherence to guideline-directed cardiovascular therapies and health outcomes.

    View details for DOI 10.1016/j.jacc.2023.03.414

    View details for Web of Science ID 001011238200001

    View details for PubMedID 37225364

  • Spending on Insulin by US Payers and Patients From 2008 to 2017 DIABETES CARE Chiu, N., Aggarwal, R., Hernandez, I., Wadhera, R., Dejong, C., Tseng, C., Yeh, R. W., Kazi, D. S. 2022; 45 (11): E163-E164

    View details for DOI 10.2337/dc22-0054

    View details for Web of Science ID 000905198100006

    View details for PubMedID 36041194

  • A Pilot Program to Teach Pharmacy Students Practical Skills to Navigate Drug Insurance Benefits PHARMACY Masuda, C., Huynh, T., Wong, V., DeJong, C., Tseng, C. 2022; 10 (1)

    Abstract

    Pharmacists must be able to navigate prescription drug coverages to help providers and patients reduce out-of-pocket costs. Traditionally, curricula on drug insurance benefits rely on lectures and lack a practicum that offers students hands-on experience with determining formulary and cost-sharing information. An activity for pharmacy students to update a free public website that summarizes formularies and copayment requirements across major insurers was piloted. Pharmacy students were trained to locate online formularies and identify a drug's coverage tier, step therapy, prior authorization, and cost-sharing during a 6-week experiential rotation. Students checked formularies from six insurance plans for 250-plus drugs across 15 health conditions. Graduates were surveyed (74% response rate) about the activities' impact on their learning and ability to navigate drug benefits. Respondents rated the training as helpful in learning whether a drug was covered (100%), or required step therapy or prior authorization (100%). The majority of graduates reported being able to look up formulary coverage (90%), step therapy or prior authorization (90%), and copayment requirements (65%). Our innovative skills-based pilot activity was effective in teaching pharmacy students to navigate insurance formularies, which is essential for helping patients access medications.

    View details for DOI 10.3390/pharmacy10010023

    View details for Web of Science ID 000762856900001

    View details for PubMedID 35202072

    View details for PubMedCentralID PMC8878890

  • Patients' Compliance With Quarantine Requirements for Exposure or Potential Symptoms of COVID-19. Hawai'i journal of health & social welfare Tseng, C., Roh, Y., DeJong, C., Kanagusuku, L. N., Soin, K. S. 2021; 80 (11): 276-282

    Abstract

    Reducing Coronavirus disease 2019 (COVID-19) transmission relies on people quarantining after exposure to COVID-19 or if they experience COVID-19 symptoms, and isolating from others if COVID-19 positive. Quarantine and isolation last 10 to 14 days and can be state-mandated; however, the level of compliance is unknown. The University of Hawai'i Department of Family Medicine clinic called patients instructed by our physicians to quarantine for exposure risk or symptoms of potential COVID-19 infection between March 15, 2020, and April 15, 2020. None of the patients tested positive for COVID-19. Sixty-nine of 90 (77%) patients completed follow-up calls and self-reported whether they had stayed home. Of these 69 patients, 32 (46%) broke quarantine to buy groceries (36%), work (9%), visit others (6%), or for other reasons (12%). For patients living alone, 8 of 11 (73%) left home to buy groceries. For employed patients, 6 of 39 (15%) returned to work during their quarantine period. Nearly half of our patients did not quarantine for the entire period. Many persons left home to buy food or to work. Strong public health messaging is needed to educate communities about the requirement to quarantine. Clinicians can help by asking patients about social and financial ability to quarantine, schedule follow-up appointments to remind patients to stay home, and link patients to food programs, financial assistance, and other community resources to successfully quarantine and prevent COVID-19 transmission.

    View details for PubMedID 34765987

  • Tenofovir-based PrEP for COVID-19: an untapped opportunity? AIDS DeJong, C., Spinelli, M. A., Okochi, H., Gandhi, M. 2021; 35 (9): 1509-1511

    View details for DOI 10.1097/QAD.0000000000002877

    View details for Web of Science ID 000680438200022

    View details for PubMedID 33710026

    View details for PubMedCentralID PMC8243808

  • Association Between Industry Marketing Payments and Prescriptions for PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitors in the United States CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES Inoue, K., Figueroa, J. F., DeJong, C., Tsugawa, Y., Orav, E., Shen, C., Kazi, D. S. 2021; 14 (5): e007521

    Abstract

    Marketing payments from the pharmaceutical industry to physicians have come under scrutiny due to their potential to influence clinical decision-making. Two proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were approved by the US Food and Drug Administration in 2015 for reducing low-density lipoprotein cholesterol in high-risk patients, but their initial uptake was limited due to their high-cost and stringent prior authorization requirements. We sought to investigate the association between industry marketing and early adoption of PCSK9i among US physicians.We used nationwide databases of primary care physicians, cardiologists, and endocrinologists treating Medicare beneficiaries to examine the association between PCSK9i-related marketing payments in 2016 and the number of filled PCSK9i prescriptions in 2017, after adjusting for physician characteristics. In subgroup analyses, we stratified our analyses by physician specialty and prior experience with prescribing PCSK9i.Among 209 840 physicians included in this analysis, 49 341 (24%) physicians received 292 941 PCSK9i-related marketing payments in 2016. The total value of these payments was $19 million, with a median payment of $61 per physician (interquartile range, $25-$132). Most payments (95%) were for meals, with a median of $14 per meal. The receipt of PCSK9i-related payments in 2016 was associated with increased PCSK9i prescription in 2017 (adjusted risk ratio, 3.18 [95% CI, 2.95-3.42]). This association was larger among primary care physicians (adjusted risk ratio, 6.67 [95% CI, 5.87-7.57]) than cardiologists (adjusted risk ratio, 2.00 [95% CI, 1.84-2.16]) and endocrinologists (adjusted risk ratio, 4.06 [95% CI, 2.95-5.59]). The association was observed across all types of payments.At a time when few physicians had experience with prescribing PCSK9i under strict prior authorization requirements, industry marketing payments to physicians for PCSK9i, predominantly in the form of meals, were associated with increased PCSK9i prescription in the subsequent year.

    View details for DOI 10.1161/CIRCOUTCOMES.120.007521

    View details for Web of Science ID 000651603400007

    View details for PubMedID 33966446

  • Trends in the Use of Angiotensin-Converting Enzyme Inhibitor and Angiotensin-II Receptor Blocker Among United States Adults From 1999 to 2018 ENDOCRINE PRACTICE Inoue, K., DeJong, C., Nangaku, M. 2021; 27 (5): 503-504

    View details for DOI 10.1016/j.eprac.2020.12.008

    View details for Web of Science ID 000644659800018

    View details for PubMedID 33934755

  • Deferral of Care for Serious Non-COVID-19 Conditions A Hidden Harm of COVID-19 JAMA INTERNAL MEDICINE DeJong, C., Katz, M. H., Covinsky, K. 2021; 181 (2): 274

    View details for DOI 10.1001/jamainternmed.2020.4016

    View details for Web of Science ID 000586741400002

    View details for PubMedID 33104166

  • Multivessel or Culprit Vessel-Only Percutaneous Coronary Intervention for Patients With Acute Myocardial Infarction and Cardiogenic Shock Real-World Evidence in Support of CULPRIT-SHOCK JAMA INTERNAL MEDICINE DeJong, C., Redberg, R. F. 2020; 180 (10): 1280-1283

    View details for DOI 10.1001/jamainternmed.2020.3400

    View details for Web of Science ID 000582383200006

    View details for PubMedID 32833000

  • Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D JAMA INTERNAL MEDICINE DeJong, C., Masuda, C., Chen, R., Kazi, D. S., Dudley, R., Tseng, C. 2020; 180 (12): 1696-1699

    Abstract

    This study examines cost sharing for novel second-line diabetes treatment agents under Medicare Part D.

    View details for DOI 10.1001/jamainternmed.2020.2922

    View details for Web of Science ID 000572382700004

    View details for PubMedID 32926091

    View details for PubMedCentralID PMC7490744

  • Inclusion Across the Lifespan in Cardiovascular Trials-A Long Road Ahead JAMA INTERNAL MEDICINE DeJong, C., Covinsky, K. 2020; 180 (11): 1533-1534

    View details for DOI 10.1001/jamainternmed.2020.2735

    View details for Web of Science ID 000573901000008

    View details for PubMedID 32897305

  • The Risks of Prescribing Hydroxychloroquine for Treatment of COVID-19-First, Do No Harm JAMA INTERNAL MEDICINE DeJong, C., Wachter, R. M. 2020; 180 (8): 1118-1119

    View details for DOI 10.1001/jamainternmed.2020.1853

    View details for Web of Science ID 000561264100018

    View details for PubMedID 32347894

  • An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DeJong, C., Chen, A., Lo, B. 2020; 323 (23): 2367-2368

    View details for DOI 10.1001/jama.2020.8914

    View details for Web of Science ID 000543376700010

    View details for PubMedID 32412580

  • Continuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Face of Kidney Disease Progression-Safe and Possibly Life Saving JAMA INTERNAL MEDICINE DeJong, C., Grant, R. W. 2020; 180 (5): 727

    View details for DOI 10.1001/jamainternmed.2020.0300

    View details for Web of Science ID 000534043600020

    View details for PubMedID 32150238

  • Addressing Mistreatment in Medical Education JAMA INTERNAL MEDICINE Thakkar, A. B., Dejong, C., Katz, M. H. 2020; 180 (5): 665

    View details for DOI 10.1001/jamainternmed.2020.0004

    View details for Web of Science ID 000534043600011

    View details for PubMedID 32091570

  • Disclosure of Article Funding and Conflicts of Interest in High-Impact Clinical Journals JOURNAL OF GENERAL INTERNAL MEDICINE Anderson, T. S., DeJong, C., Good, C. B., Gellad, W. F. 2020; 35 (4): 1345-1347

    View details for DOI 10.1007/s11606-019-05378-9

    View details for Web of Science ID 000515804100004

    View details for PubMedID 32016701

    View details for PubMedCentralID PMC7174528

  • Shining a Light on Industry Payments to Health Care Professionals Who Are Not Physicians JAMA INTERNAL MEDICINE DeJong, C., Steinbrook, R. 2019; 179 (10): 1432-1433

    View details for DOI 10.1001/jamainternmed.2019.1367

    View details for Web of Science ID 000492026400025

    View details for PubMedID 31180496

  • Assessment of National Coverage and Out-of-Pocket Costs for Sacubitril/Valsartan Under Medicare Part D JAMA CARDIOLOGY DeJong, C., Kazi, D. S., Dudley, R., Chen, R., Tseng, C. 2019; 4 (8): 828-830

    Abstract

    This study examines the insurance coverage and out-of-pocket costs to Medicare beneficiaries for the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan.

    View details for DOI 10.1001/jamacardio.2019.2223

    View details for Web of Science ID 000484368800020

    View details for PubMedID 31290933

    View details for PubMedCentralID PMC6624798

  • Supplemental Security Income and the Health of Low-Income Adults JAMA INTERNAL MEDICINE DeJong, C., Katz, M. H. 2019; 179 (6): 843-844

    View details for DOI 10.1001/jamainternmed.2019.0058

    View details for Web of Science ID 000470823400025

    View details for PubMedID 30933212

  • Electrocardiographic Harbingers of Ventricular Tachycardia Arrest-A Moment of Pause JAMA INTERNAL MEDICINE DeJong, C., Nishtala, A., Goldschlager, N. 2019; 179 (2): 249-251

    View details for DOI 10.1001/jamainternmed.2018.6220

    View details for Web of Science ID 000457567500021

    View details for PubMedID 30477008

  • Validation of Prediction Models for Critical Care Outcomes Using Natural Language Processing of Electronic Health Record Data. JAMA network open Marafino, B. J., Park, M., Davies, J. M., Thombley, R., Luft, H. S., Sing, D. C., Kazi, D. S., DeJong, C., Boscardin, W. J., Dean, M. L., Dudley, R. A. 2018; 1 (8): e185097

    Abstract

    Accurate prediction of outcomes among patients in intensive care units (ICUs) is important for clinical research and monitoring care quality. Most existing prediction models do not take full advantage of the electronic health record, using only the single worst value of laboratory tests and vital signs and largely ignoring information present in free-text notes. Whether capturing more of the available data and applying machine learning and natural language processing (NLP) can improve and automate the prediction of outcomes among patients in the ICU remains unknown.To evaluate the change in power for a mortality prediction model among patients in the ICU achieved by incorporating measures of clinical trajectory together with NLP of clinical text and to assess the generalizability of this approach.This retrospective cohort study included 101 196 patients with a first-time admission to the ICU and a length of stay of at least 4 hours. Twenty ICUs at 2 academic medical centers (University of California, San Francisco [UCSF], and Beth Israel Deaconess Medical Center [BIDMC], Boston, Massachusetts) and 1 community hospital (Mills-Peninsula Medical Center [MPMC], Burlingame, California) contributed data from January 1, 2001, through June 1, 2017. Data were analyzed from July 1, 2017, through August 1, 2018.In-hospital mortality and model discrimination as assessed by the area under the receiver operating characteristic curve (AUC) and model calibration as assessed by the modified Hosmer-Lemeshow statistic.Among 101 196 patients included in the analysis, 51.3% (n = 51 899) were male, with a mean (SD) age of 61.3 (17.1) years; their in-hospital mortality rate was 10.4% (n = 10 505). A baseline model using only the highest and lowest observed values for each laboratory test result or vital sign achieved a cross-validated AUC of 0.831 (95% CI, 0.830-0.832). In contrast, that model augmented with measures of clinical trajectory achieved an AUC of 0.899 (95% CI, 0.896-0.902; P < .001 for AUC difference). Further augmenting this model with NLP-derived terms associated with mortality further increased the AUC to 0.922 (95% CI, 0.916-0.924; P < .001). These NLP-derived terms were associated with improved model performance even when applied across sites (AUC difference for UCSF: 0.077 to 0.021; AUC difference for MPMC: 0.071 to 0.051; AUC difference for BIDMC: 0.035 to 0.043; P < .001) when augmenting with NLP at each site.Intensive care unit mortality prediction models incorporating measures of clinical trajectory and NLP-derived terms yielded excellent predictive performance and generalized well in this sample of hospitals. The role of these automated algorithms, particularly those using unstructured data from notes and other sources, in clinical research and quality improvement seems to merit additional investigation.

    View details for DOI 10.1001/jamanetworkopen.2018.5097

    View details for PubMedID 30646310

    View details for PubMedCentralID PMC6324323

  • Continuing Problems With Financial Conflicts of Interest and Clinical Practice Guidelines JAMA INTERNAL MEDICINE DeJong, C., Steinbrook, R. 2018; 178 (12): 1715

    View details for DOI 10.1001/jamainternmed.2018.4974

    View details for Web of Science ID 000452113900029

    View details for PubMedID 30383081

  • Nationwide Coverage and Cost-Sharing for PCSK9 Inhibitors Among Medicare Part D Plans JAMA CARDIOLOGY Kazi, D. S., Lu, C. Y., Lin, G. A., DeJong, C., Dudley, R., Chen, R., Tseng, C. 2017; 2 (10): 1164-1166

    Abstract

    This study examines PCSK9i cost-sharing requirements for Medicare Part D plans nationwide, which insure 41 million beneficiaries.

    View details for DOI 10.1001/jamacardio.2017.3051

    View details for Web of Science ID 000413247700023

    View details for PubMedID 28903137

    View details for PubMedCentralID PMC5815006

  • Reconsidering Physician-Pharmaceutical Industry Relationships JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DeJong, C., Dudley, R. 2017; 317 (17): 1772-1773

    View details for DOI 10.1001/jama.2017.4455

    View details for Web of Science ID 000400440700034

    View details for PubMedID 28464124

  • Medicare Part D Plans' Coverage and Cost-Sharing for Acute Rescue and Preventive Inhalers for Chronic Obstructive Pulmonary Disease JAMA INTERNAL MEDICINE Tseng, C., Yazdany, J., Dudley, R., DeJong, C., Kazi, D. S., Chen, R., Lin, G. A. 2017; 177 (4): 585-588

    View details for DOI 10.1001/jamainternmed.2016.9386

    View details for Web of Science ID 000398425200032

    View details for PubMedID 28241217

    View details for PubMedCentralID PMC6822611

  • Important Distinctions Concerning Pharmaceutical Company-Sponsored Meals and Prescribing Patterns Reply JAMA INTERNAL MEDICINE DeJong, C., Tseng, C., Dudley, R. 2016; 176 (12): 1881

    View details for DOI 10.1001/jamainternmed.2016.7157

    View details for Web of Science ID 000390255700045

    View details for PubMedID 27918818

  • Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries JAMA INTERNAL MEDICINE DeJong, C., Aguilar, T., Tseng, C., Lin, G. A., Boscardin, W., Dudley, R. 2016; 176 (8): 1114-1122

    Abstract

    The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available.To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries.Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 drug classes: statins, cardioselective β-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015.Receipt of an industry-sponsored meal promoting the drug of interest.Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting.A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.

    View details for DOI 10.1001/jamainternmed.2016.2765

    View details for Web of Science ID 000381145000021

    View details for PubMedID 27322350

  • VARIATION IN QUALITY OF CARE PROVIDED DURING COMMERCIAL VIRTUAL VISITS IN URGENT CARE: A STANDARDIZED PATIENT AUDIT STUDY Schoenfeld, A. J., Davies, J., Marafino, B., Dean, M. L., Dejong, C., Bardach, N., Kazi, D., Boscardin, W., Lin, G. A., Duseja, R., Mei, J., Mehrotra, A., Dudley, R. SPRINGER. 2016: S466-S467

    View details for Web of Science ID 000392201601311

  • Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits JAMA INTERNAL MEDICINE Schoenfeld, A. J., Davies, J. M., Marafino, B. J., Dean, M., DeJong, C., Bardach, N. S., Kazi, D. S., Boscardin, W., Lin, G. A., Duseja, R., Mei, Y., Mehrotra, A., Dudley, R. 2016; 176 (5): 635-642

    Abstract

    Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed.To assess the variation in the quality of urgent health care among virtual visit companies.This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015.Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions.Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40.4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found.Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.

    View details for DOI 10.1001/jamainternmed.2015.8248

    View details for Web of Science ID 000375292500018

    View details for PubMedID 27042813

    View details for PubMedCentralID PMC6842573

  • Incorporating a New Technology While Doing No Harm, Virtually JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DeJong, C., Lucey, C. R., Dudley, R. 2015; 314 (22): 2351-2352

    View details for DOI 10.1001/jama.2015.13572

    View details for Web of Science ID 000365989100005

    View details for PubMedID 26647252

  • Websites That Offer Care Over the Internet Is There an Access Quality Tradeoff? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DeJong, C., Santa, J., Dudley, R. 2014; 311 (13): 1287-1288

    View details for DOI 10.1001/jama.2014.1026

    View details for Web of Science ID 000333645400007

    View details for PubMedID 24691602

  • Short Communication New HIV Infections at Southern New England Academic Institutions: Implications for Prevention AIDS RESEARCH AND HUMAN RETROVIRUSES Chan, P. A., Kazi, S., Rana, A., Blazar, I., Dejong, C. C., Mayer, K. H., Huard, T. K., Carleton, K., Gillani, F., Alexander, N., Parillo, Z., Flanigan, T. P., Kantor, R. 2013; 29 (1): 25-29

    Abstract

    New HIV infections among younger men who have sex with men (MSM) in the United States are escalating. Data on HIV infections in college students are limited. In 2010, three MSM college students presented to our clinic with primary HIV infection (PHI) in a single month. To determine the number of college students among new HIV diagnoses, we reviewed clinical characteristics and molecular epidemiology of HIV-diagnosed individuals from January to December 2010 at the largest HIV clinic in Southern New England. PHI was defined as acute HIV infection or seroconversion within the last 6 months. Of 66 individuals diagnosed with HIV in 2010, 62% were MSM and 17% were academic students (12% college or university, 5% other). Seventy-three percent of students were MSM. Compared to nonstudents, students were more likely to be younger (24 versus 39 years), born in the United States (91% versus 56%), have another sexually transmitted disease (45% versus 11%), and present with PHI (73% versus 16%, all p-values<0.05). Thirty percent of individuals formed eight transmission clusters including four students. MSM were more likely to be part of clusters. Department of Health contact tracing of cluster participants allowed further identification of epidemiological linkages. Given these high rates of PHI in recently diagnosed students, institutions of higher education should be aware of acute HIV presentation and the need for rapid diagnosis. Prevention strategies should focus on younger MSM, specifically college-age students who may be at increased risk of HIV infection.

    View details for DOI 10.1089/aid.2012.0130

    View details for Web of Science ID 000313036800005

    View details for PubMedID 22724920

    View details for PubMedCentralID PMC3537304

https://orcid.org/0000-0003-0514-3193