Skip to content

2026 ACG User Summit
September 20 – 22 | Orlando, FL
Register Now

Documents

Documents

Apples and Oranges: Four Definitions of Multiple Chronic Conditions and their Relationship to 30-Day Hospital Readmission

OBJECTIVES: To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) and compare each definition’s ability to predict 30-day […]

Are we making a difference in primary care for adults with intellectual and developmental disabilities?

Abstract Objectives. To examine the impact of the dissemination of guidelines to physicians and of a population-level health communication intervention on the percentage of adults […]

Supplement to “Equilibria in Health Exchanges: Adverse Selection versus Reclassification Risk”

This online appendix has three sections.  The first presents details of the choice model estimation algorithm, as well as additional estimates from our primary specification […]

Repeat Emergency Department Visits for Individuals With Intellectual and Developmental Disabilities and Psychiatric Disorders

Abstract Although individuals with intellectual and developmental disabilities (IDD) and psychiatric concerns are more likely than others to visit hospital emergency departments (EDs), the frequency […]

Integrating Social and Behavioral Determinants of Health into Population Health Analytics: A Conceptual Framework and Suggested Road Map

Abstract There is growing recognition that social and behavioral risk factors impact population health outcomes. Interventions that target these risk factors can improve health outcomes. […]

Frailty, Implantable Cardioverter Defibrillators, and Mortality: a Systematic Review

Abstract   Background Evidence for the benefit of implantable cardioverter defibrillators (ICD) in preventing sudden cardiac death (SCD) in older adults is mixed; age alone […]

Impact of care provider network characteristics on patient outcomes: Usage of social network analysis and a multi-scale community detection

Abstract Objective We assess healthcare provider collaboration and the impact on patient outcomes using social network analysis, a multi-scale community detection algorithm, and generalized estimating […]

MS risk in immigrants in the McDonald era: A population-based study in Ontario, Canada

Abstract OBJECTIVE To determine risk factors for multiple sclerosis (MS) in immigrants and to compare MS risk in immigrants and long-term residents in Ontario, Canada. […]

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Abstract Background To investigate the effect of frailty on short‐term postoperative outcomes and total hospital charges (THCs) in patients with non‐metastatic upper urinary tract carcinoma, […]

Who is discharged to intermediate care facilities? An Italian study in the population of Udine

ABSTRACT The objective of this study was to assess complexity of patients discharged from hospital to intermediate care facility in an Italian setting. Multiple anonymous […]

Alive and at home: Five-year outcomes in older adults following emergency general surgery

Abstract BACKGROUND While the short-term risks of emergency general surgery (EGS) admission among older adults have been studied, little is known about long-term functional outcomes […]

Shorter Diagnosis-to-Treatment Interval in Diffuse Large B-Cell Lymphoma is Associated With Inferior Overall Survival in a Large, Population-Based Registry

Abstract Background Because of prolonged screening requirements, patient and time-dependent selection have been proposed as potential biases in clinical trials. The screening process may exclude […]

Association of Preexisting Disability With Severe Maternal Morbidity or Mortality in Ontario, Canada

Abstract Objective To determine the risk of severe maternal morbidity or mortality among women with a physical, sensory, or intellectual/developmental disability compared with women without […]

Integrating E-Prescribing and Pharmacy Claims Data for Predictive Modeling: Comparing Costs and Utilization of Health Plan Members Who Fill Their Initial Medications with Those Who Do Not

Abstract BACKGROUND Nonfilling of prescribed medications is a worldwide problem of serious concern. Studies of health care costs and utilization associated with medication nonadherence frequently […]

Delay of Pregnancy Among Physicians vs Nonphysicians

Abstract Importance Women physicians may delay childbearing and experience childlessness more often than nonphysicians, but existing knowledge is based largely on self-reported survey data. Objective […]

How different combinations of comorbidities affect healthcare use by elderly patients with obstructive lung disease

Abstract Objective Previous research had shown the number of comorbidities is a major factor influencing the burden of care for elderly patients with obstructive lung […]

Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Abstract Objective To compare 4-year health care expenditures after RYGB vs sleeve gastrectomy, identify factors independently associated with 4-year health care expenditures, and compare the […]

No Difference in Outcomes Between Short and Longer-Stay Total Joint Arthroplasty with a Discharge Home

Abstract Background: Outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a short length of hospital stay have been reported; however, most […]

Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial

Abstract Objective To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer. Design Pragmatic, cluster randomised trial. Setting […]

Case Study: The Distilling of a Biased Algorithmic Decision System through a Business Lens

Abstract Technological advances embedded within algorithmic decision systems are being deployed every day. Some of these investments are unquestionably worthwhile, while some others prioritize commercialization […]

The Effect of Depression on Paid Sick Leave due to Metabolic and Cardiovascular Disease in low-wage workers. (Depression and Sick Leave)

Abstract Background Colombia’s health system allows workers to claim paid sick leave due to health conditions, some of this conditions are related to metabolic and […]

Changing patterns of multimorbidity among patients with ambiguous diagnoses: The case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Abstract Introduction Increased attention has been given to multimorbidity. This phenomenon often has been explored through associations between diseases based on the frequency of combinations […]

Association of frailty with perioperative and survival outcomes in patients with gynecologic cancers: A population-based study

Abstract Objectives The relationship between frailty and both short- and long-term outcomes remains underexplored in gynecologic oncology (GO). We sought to evaluate the association of […]

Impact of frailty on outcomes after multiple rib fractures and flail chest undergoing surgical stabilization of rib fractures: a propensity score-matched analysis of the Nationwide Inpatient Sample 2005–2020

Abstract Background This study examined the impact of frailty on in-hospital outcomes in patients undergoing surgical stabilization of multiple rib fractures and flail chest (SSRF). […]

COVID-19 Vaccination, Hospitalization Rates, and Mortality Differ Between People with Diagnosed Immune Mediated Inflammatory Disease and the General Population: A Population-Based Study

Abstract Background: Vaccination reduces Coronavirus disease-19 (COVID-19) infection severity. We evaluated COVID-19 vaccine uptake and effectiveness in people with immune mediated inflammatory diseases (pIMIDs) versus […]

Machine learning identifies clusters of multimorbidity among decedents with inflammatory bowel disease

Abstract Background: Multimorbidity is the co-occurrence of two or more chronic conditions in one person. Providing quality, patient-centered care requires understanding multimorbidity. Our objective was […]

Trends in use of poly (ADP-ribose) polymerase inhibitor (PARPi) in ovarian cancer

Abstract Background To assess population-level trends in use of poly (ADP-ribose) polymerase inhibitors (PARPis) among ovarian cancer patients in the years following initial FDA approvals. […]

Factors Associated With the Receipt of Female Breast Cancer Treatment Among People Living With Intellectual or Developmental Disabilities: A Population-Based Retrospective Cohort Study

ABSTRACT Background People with intellectual or developmental disabilities (IDD) experience breast cancer care inequities relative to those without IDD. Identifying factors associated with receipt of […]

Twenty-Five Year Outcomes of Patients Undergoing Valve Surgery for Infective Endocarditis

ABSTRACT Objectives Infective endocarditis is associated with significant morbidity and mortality. Long-term outcome data after surgery are limited. We sought to analyze 25-year outcomes following […]

Physician Work Patterns in Pregnancy, Parental Leave, and Return to the Workforce

Abstract Importance Pregnancy and parental leave remain poorly supported in medical culture, yet little is known about how physicians adjust their workloads around childbirth. Objective […]

Can high-cost spending in the community signal admission to hospital? A dynamic modeling study for urgent and elective cardiovascular patients

Abstract Background Much of the research on high-cost patients in healthcare has taken a static approach to studying what is actually a dynamic process. High-cost […]

Featured thumbnail
Population Health Management: Innovations in Risk Adjustment and Predictive Modeling

Jonathan Weiner, DrPH participated as one of the featured presenters in the 8th Annual Predictive Modeling Web Summit. Watch the below recording of Dr. Weiner’s […]

Featured thumbnail
Using EHR’s Unstructured Data for Risk Stratification

Presented by: Hadi Kharrazi, MHI, MD, PhD
Asst. Professor, JH School of Public Health; Asst. Professor, JH School of Medicine; Research Director, JHCPHIT

This presentation focuses on the potential role of EHR’s unstructured data in identifying frailty markers and improving the prediction of utilization outcomes.

Attention-deficit/hyperactivity disorder in children: excess costs before and after initial diagnosis and treatment cost differences by ethnicity

Arch Pediatr Adolesc Med 160:1063-1069. Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, CA, USA OBJECTIVES: To estimate the excess costs […]

Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study

Ann Intern Med 161:242-248. London Health Sciences Centre, London, ON, Canada; St. Michael’s Hospital, Toronto, ON, Canada; Yale University and Veterans Affairs Medical Center, New […]

Conspicuous consumption: characterizing high users of physician services in one Canadian province

J Health Serv Res Policy 8:215-224. http://www.ncbi.nlm.nih.gov/pubmed/14596756. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada OBJECTIVES: To examine medical […]

A population-based study of ethnicity and breast cancer stage at diagnosis in Ontario

Curr Oncol 22:97-104. Women’s College Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: […]

READMIT: A clinical risk index to predict 30-day readmission after discharge from acute psychiatric units

J Psychiatr Res 61:205-213. Women’s College Hospital, Toronto, ON, Canada; Women’s College Research Institute, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; […]

Geriatric conditions in patients undergoing defibrillator implantation for prevention of sudden cardiac death: prevalence and impact on mortality

Circ Cardiovasc Qual Outcomes 9:23-30. Johns Hopkins University Baltimore, MD, USA; Yale School of Medicine, New Haven, CT, USA; University of Colorado, Aurora, CO, USA; […]

Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study

J Hypertens 33:221-2222. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Veterans Affairs Pittsburgh Healthcare System. Pittsburgh, PA, USA; University of […]

Intraarticular hip injection and early revision surgery following total hip arthroplasty: a retrospective cohort study

Arthritis Rheumatol 67:162-168. University of Toronto, Toronto, Ontario, Canada OBJECTIVE: Therapeutic intraarticular injections are used in the management of hip osteoarthritis (OA). Some studies suggest […]

Adjusting for case mix and social class in examining variation in home visits between practices

Fam Pract 21:355-363. Public Health Policy Unit, School of Public Policy, University College London, London, UK OBJECTIVES: The purpose of this study was to investigate […]

Profiling primary care physician resource use: examining the application of case mix adjustment

J Ambul Care Manage 19:60-80. Health Services Research and Development Center, Johns Hopkins School of Public Health, Baltimore, MD, USA Growing emphasis on managed care […]

Towards a more equitable distribution of resources and assessment of quality of care: validation of a comorbidity based case-mix system

Harefuah 149:665-669. Published in Hebrew. Planning & Health Policy Division, Clalit Health Services Head Offices, Israel BACKGROUND: Equitable distribution of healthcare resources and fair assessments […]

Forecasting physician workforce requirements

JAMA 273:111; author reply 113. Dr Weiner1 presents an exacting analysis of the likely effects of health system reform on physician workforce requirements. His market approach […]

Healthcare utilization patterns and risk adjustment under Taiwan’s National Health Insurance system

J Formos Med Assoc 101:52-59. Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan BACKGROUND AND PURPOSE: Some […]

The predictors of self-rated health and the relationship between self-rated health and health service needs are similar across socioeconomic groups in Canada

J Clin Epidemiol 63:412-421. Institute for Work and Health, Toronto, ON, Canada OBJECTIVE: To examine if there are systematic differences in the predictors of self-rated […]

The economic impact of a disability prevention program

J Occup Environ Med 52:15-21. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA We evaluated the effect […]

Predictive modeling of total healthcare costs using pharmacy claims data: a comparison of alternative econometric cost modeling techniques

Med Care 43:1065-1072. Caremark, Hunt Valley, MD, USA OBJECTIVE: We sought to evaluate several statistical modeling approaches in predicting prospective total annual health costs (medical […]

The mortality risk score and the ADG score: two points-based scoring systems for the Johns Hopkins aggregated diagnosis groups to predict mortality in a general adult population cohort in Ontario, Canada

Med Care 49:940-947. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Logistic regression models that incorporated age, sex, and indicator variables for the Johns […]

Association of antiepileptic drugs with nontraumatic fractures: a population-based analysis

Arch Neurol 68:107-112. Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, AB, Canada OBJECTIVE: To explore the relationship between antiepileptic drug (AED) use […]

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

Am J Public Health 88:1539-1541. Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA OBJECTIVES: This study examined the effect of continuity […]

Health of Medicare Advantage plan enrollees at 1 year after Hurricane Katrina

Am J Manag Care 15:13-22. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA OBJECTIVE: To assess the effects of Hurricane Katrina on mortality, […]

Chiropractic use by urban and rural residents with insurance coverage

J Rural Health 25:253-258. Department of Health Services, University of Washington, Seattle, WA, USA PURPOSE: To describe the use of chiropractic care by urban and […]

Case-mix and variation in specialist referrals in general practice

Br J Gen Pract 55:529-533. University College London Hospital NHS Trust, London, UK BACKGROUND: The potential of a comprehensive measure of patient morbidity to explain […]

US primary care delivery after the Health Center Growth Initiative: comparison of health centers, hospital outpatient departments, and physicians’ offices

J Ambul Care Manage 35:60-74. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA We compared patient management […]

Depression and use of health care services in patients with advanced cancer

Can Fam Physician 59:e168-e174. University Health Network, Toronto, ON, Canada OBJECTIVE: To examine whether depression in patients with advanced cancer is associated with increased rates […]

Future complexity of care tier affected by depression outcomes

J Prim Care Community Health 5:30-35. Mayo Clinic, Rochester, MN, USA. BACKGROUND: The inclusion of mental health issues in the evaluation of multimorbidity generally has […]

Modelling the ability of risk adjusters to reduce adverse selection in managed care

Appl Health Econ Health Policy 3:107-114. Stanford Prevention Research Center, Stanford University Medical School, Stanford, CA, USA Population-based risk adjustment, as applied to reimbursement in […]

Antihypertensive adherence and drug class among Asian Pacific Americans

Ethn Health 12:265-281. Hawaii Medical Service Association, Honolulu, HI, USA OBJECTIVE: Research on adherence has emphasized the need to consider patient ethnicity when developing adherence […]

Use and costs of care in retail clinics versus traditional care sites

Health Aff 27:1283-1292. HealthPartners in Minneapolis, MN, USA Erratum in Health Aff (Millwood). 2008 Nov-Dec;27(6):1751. Retail clinics have generated much interest, promising convenient, lower-cost service […]

Individual and contextual determinants of regional variation in prescription drug use: an analysis of administrative data from British Columbia

PLoS One 5:e15883. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada BACKGROUND: Increasing attention is being paid to variations […]

Comparative performance of community health centers and other usual sources of primary care

J Ambul Care Manage 34:380-390. Schneider Institutes for Health Policy, Brandeis University, Waltham, MA, USA OBJECTIVE: To determine how Community Health Centers (CHCs) perform relative […]

A population-based analysis of esophageal and gastric cardia adenocarcinomas in Ontario, Canada: incidence, risk factors, and regional variation

J Gastrointest Surg 15:782-790. Sunnybrook Health Sciences Centre, Toronto, ON, Canada INTRODUCTION: In Western countries, the incidence of esophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma […]

Use of complementary and alternative medicine providers by fibromyalgia patients under insurance coverage

Arthritis Rheum 57:71-76. University of Washington, Seattle, WA, and Boise State University, Boise, ID, USA OBJECTIVE: To quantify how visits and expenditures differ between insured […]

Two-year trends in cancer screening among low socioeconomic status women in an HMO-based high-deductible health plan

J Gen Intern Med 27:1112-9. Department of Population Medicine, Harvard Medical School, Boston, MA, USA BACKGROUND: Cancer screening is often fully covered under high-deductible health […]

Early cholecystectomy for acute cholecystitis: a population-based retrospective cohort study of variation in practice

CMAJO 1:E62-E67. University of Toronto, Toronto, ON, Canada BACKGROUND:  Despite evidence in favour of early cholecystectomy for most patients with acute cholecystitis, variation in practice […]

The impact of high-deductible health plans on men and women: an analysis of emergency department care

Med Care 51:639-645. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA BACKGROUND: Prior studies show that men […]

Predictive risk modelling in the Spanish population: a cross-sectional study

BMC Health Serv Res 13:269. Osakidetza, Basque Health Service, Bilbao, Spain. BACKGROUND: An increase in chronic conditions is currently the greatest threat to human health […]

Low-socioeconomic-status enrollees in high-deductible plans reduced high-severity emergency care

Health Aff 32:1398-1406. Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA One-third of US workers now have high-deductible health plans, and […]

Undiagnosed hypertension among young adults with regular primary care use

J Hypertens 32:65-74. University of Wisconsin School of Medicine and Public Health, Madison, WI; Veterans Affairs Pittsburgh Healthcare System and School of Pharmacy, University of […]

Age and gender differences in the prevalence and patterns of multimorbidity in the older population

BMC Geriatr 14:75. Department of Health Wellbeing and Family, Government of Aragón, Zaragoza, Spain BACKGROUND: The coexistence of several chronic diseases in one same individual, […]

The impact of influenza vaccination on hospitalizations and mortality among frail older people

J Am Med Dir Assoc 15:256-260. National Yang-Ming University, Taipei, Taiwan OBJECTIVES: The objective of this study was to evaluate the benefits of influenza vaccination […]

Federally qualified health center efficacy study

Montpelier, VT, USA: Vermont Program for Quality in Health Care. Vermont Program for Quality in Health Care, Montpelier, VT, USA OBJECTIVE: The objective of the […]

Homecare after pediatric traumatic brain injury: what do they use and how much does it cost?

Arch Phys Med Rehabil 96:e38. University Health Network, Toronto, ON, Canada Objective(s): To determine, by sex, the predictors, types, and direct cost of publicly funded […]

Trends in abdominal aneurysm surgery, 2002-2014

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences (internal report). Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Methods: We conducted a population-based cohort study […]

Building a predictive model for 30-day inpatient readmission using PROC PHREG

Presented at NESUG 2012. Baltimore, MD, USA: North East SAS User Group. Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins […]

Adverse selection, welfare and the optimal pricing of employer-sponsored health plans

St. Paul, MN, USA: University of Minnesota and NBER. University of Minnesota, St. Paul, MN, USA We assess the welfare impact of adverse selection in […]

Patterns of regional mental illness disorder diagnoses and service use in Manitoba: a population-based study

Winnepeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada Mental illness is a profound problem […]

Ambulatory Care Groups: an evaluation for military health care use

Fort Sam Houston, TX, USA: United States Army Center for Healthcare Education and Studies, publication #HR 94-004. United States Army Center for Healthcare Education and […]

Models for Medicare payment system reform based on group-specific volume performance standards (GVPS)

Waltham, MA, USA: Brandeis University. Brandeis University, Waltham, MA, USA This report discusses potential policy options for Medicare based on Group-Specific Volume Performance Standards (GVPS). […]

Aging in Ontario: an ICES chartbook of health service use by older adults

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Recent investments by the Ontario Ministry of Health and […]

Impacto economico de las enfermedades y pacientes atendidos en atencion primaria adaptacion de los Grupos Clinicos Adjustados (ACGs) en nuestro medio

Barcelona, Spain: University of Barcelona (doctoral dissertation). Published in Spanish. University of Barcelona, Barcelona, Spain El objetivo general de este trabajo es medir el impacto […]

Outcomes of care for South Carolina Medicaid managed care enrollees, state fiscal year 2007

Final report to the South Carolina Department of Health and Human Services. Columbia, SC, USA: University of South Carolina. University of South Carolina, Columbia, SC, […]

Primary health care reimbursement based on socioeconomics or disease burden

Primärvårdsersättning efter socioekonomi eller sjukdomsbörda. [Primary health care reimbursement based on socioeconomics or disease burden. Registry study from Östergötland shows different results depending on analysis […]

Implementation of electronic medical records and preventive services: a mixed methods study

Toronto, ON, Canada: University of Toronto (masters thesis). University of Toronto, Toronto, ON, Canada The implementation of Electronic Medical Records (EMRs) may lead to improved […]

Primärvården som koordinator för de mest sjuka äldre – implikationer för mål och indikatorer

In: Karlsson AK, Winberg H, ed. På väg mot en värdefull styrning. LHC Report: #1, 2012. Stockholm, Sweden: Stiftelsen Leading Health Care:150-172. Published in Swedish. […]

Demand for health among Canadians: roles of immigration status, country of origin, and year since migration

Toronto, ON, Canada: University of Toronto (doctoral dissertation). University of Toronto, Toronto, ON, Canada This thesis investigates the effects of immigration status, country of origin, […]

Complications following total joint arthroplasty in patients with rheumatoid arthritis

Toronto, ON, Canada: University of Toronto (doctoral dissertation). University of Toronto, Toronto, ON, Canada BACKGROUND: Total joint arthroplasty (TJA) is indicated in persons with end-stage […]

Working for Better Health in Wandsworth -The ACG System’s role in transforming services through innovative care models

Working for Better Health in Wandsworth -The ACG System’s role in transforming services through innovative care models

Leicester City CCG Case Study 1

Use of ACG® System output to support practices in participating in the Unplanned Admissions DES 2014-15

Predictive Models in the ACG® System: Recalibration of Existing Models and Development of New Ones

This short report provides details of the second recalibration of the existing models and the development of new models that was carried out by the […]

Health Care Reform In the US and England

The Johns Hopkins University Health Care Reform In the US and England: Commonalities and potential contribution of case-mix & predictive risk modeling tools Jonathan Weiner, […]

Applying the ACG® System to a Retrospective Electronic Database

Applying the Johns Hopkins ACG Applying the Johns Hopkins ACG Casemix Casemix System to a Retrospective Electronic Database: A 5 to a Retrospective Electronic Database: […]

Patient Identification with Incomplete Data

DST Health Solutions Patient Identification with Incomplete Data Kelsey Rauch

Tuesday(C6)-Refining Patient Risk Assessment with Clinical Lab Results-Lemke

Refining Patient Risk Assessment with Clinical Lab Results-Klaus Lemke