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Kammer J, Rahman M, Finnerty M, Layman D, Vega K, Galfalvy H, Labouliere C, Brown GK, Green K, Cummings A, Vasan P, Stanley B. Most Individuals Are Seen in Outpatient Medical Settings Prior to Intentional Self-Harm and Suicide Attempts Treated in a Hospital Setting. J Behav Health Serv Res 2021; 48:306-319. [PMID: 32627095 PMCID: PMC7782208 DOI: 10.1007/s11414-020-09717-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this quantitative retrospective study is to understand healthcare patterns prior to self-harm, which may inform prevention efforts and identify intervention sites. Medicaid claims within 30, 60, 90, and 365 days prior to hospital-treated self-harm between 11/1/2015 and 11/1/2016 in New York State (N = 7492) were examined. Numbers and proportions were calculated for all service types. Participants were predominately 15-34, female, and White. Most (97%) had prior-year services, 94% outpatient care (73% behavioral health, 90% medical), 69% emergency department (37% behavioral health, 59% medical), and 42% inpatient services (34% behavioral health, 20% medical). About 86% received services within 90 days and 80% within 60 days. Utilization was high within 30 days prior, with 69% having one or more services. Medical services were more common than behavioral health (94% versus 79% in prior year); outpatient (94%) was more common than emergency (69%) and inpatient (42%) care. Given that most patients received health services within 30 days and almost all saw providers within the year prior, the findings indicate that improved prevention efforts within the healthcare system can reduce the incidence of self-harm.
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Affiliation(s)
- Jamie Kammer
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA.
| | - Mahfuza Rahman
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Molly Finnerty
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Deborah Layman
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Katrina Vega
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Hanga Galfalvy
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Christa Labouliere
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104-3309, USA
| | - Kelly Green
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104-3309, USA
| | - Anni Cummings
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Prabu Vasan
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Barbara Stanley
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
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Development and Validation of an Administrative Claims-based Measure for All-cause 30-day Risk-standardized Readmissions After Discharge From Inpatient Psychiatric Facilities. Med Care 2019; 58:225-233. [DOI: 10.1097/mlr.0000000000001275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Breslau J, Pritam R, Guarasi D, Horvitz-Lennon M, Finnerty M, Yu H, Leckman-Westin E. Predictors of Receipt of Physical Health Services in Mental Health Clinics. Community Ment Health J 2019; 55:1279-1287. [PMID: 30963350 PMCID: PMC7338040 DOI: 10.1007/s10597-019-00399-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Abstract
To inform efforts to improve physical health care for adults with serious mental illness, this study examines predictors of provision and receipt of physical health services in freestanding mental health clinics in New York state. The number of services provided over the initial 12-months of implementation varied across clinics from 0 to 1407. Receipt of services was associated with a diagnosis of schizophrenia, frequent mental and physical health visits in the prior year, and prescription of antipsychotic medications. Additional support may also be needed to enable clinics to target patients without established patterns of frequent mental health or medical visits.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | | | - Molly Finnerty
- Langone Medical Center, New York University, New York, NY, 10016, USA
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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Yan T, Greene M, Chang E, Broder MS, Touya M, Munday J, Hartry A. Hospitalization risk factors in antipsychotic-treated schizophrenia, bipolar I disorder or major depressive disorder. J Comp Eff Res 2019; 8:217-227. [DOI: 10.2217/cer-2018-0090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: To examine hospitalization risk factors in antipsychotic-treated patients with schizophrenia, bipolar I disorder (BD-I) or major depressive disorder (MDD). Patients & methods: Using Truven Health MarketScan® Commercial, Medicaid and Medicare Supplemental data (01/01/2012–06/30/2016), logistic regression models were performed to identify risk factors for both psychiatric and all-cause hospitalization in three separate analyses. Results: Significant risk factors included prior hospitalization (schizophrenia: odds ratio [95% CI]: 2.83 [2.50–3.21; psychiatric]; 2.58 [2.31–2.87; all-cause]; BD-I: 2.42 [2.23–2.63]; 2.09 [1.96–2.23]; MDD: 2.81 [2.49–3.16]; 2.21 [2.03–2.40]), previous antipsychotic treatment (schizophrenia: 1.71 [1.52–1.93]; 1.31 [1.18–1.46]; BD-I: 1.33 [1.23–1.44]; 1.22 [1.14–1.30]; MDD: 1.31 (1.11–1.54); 1.17 (1.04–1.32) and substance abuse (schizophrenia: 1.42 [1.27–1.60]; 1.37 [1.23–1.53]; BD-I: 1.72 [1.58–1.86]; 1.61 [1.50–1.72]; MDD: 1.90 [1.68–2.15] and 1.55 [1.41–1.71]). Conclusion: Prior hospitalization, previous antipsychotic treatment and substance abuse were associated with increased hospitalization risk in schizophrenia, BD-I or MDD.
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Affiliation(s)
- Tingjian Yan
- Health Services Research, Partnership for Health Analytic Research, LLC, 280 S Beverly Dr, Beverly Hills, CA 90212, USA
| | - Mallik Greene
- Health Economics and Outcomes Research, Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ 08540, USA
| | - Eunice Chang
- Health Services Research, Partnership for Health Analytic Research, LLC, 280 S Beverly Dr, Beverly Hills, CA 90212, USA
| | - Michael S Broder
- Health Services Research, Partnership for Health Analytic Research, LLC, 280 S Beverly Dr, Beverly Hills, CA 90212, USA
| | - Maëlys Touya
- Health Economics and Outcomes Research, Lundbeck, 6 Parkway North, Deerfield, IL 60015, USA
| | - Jennifer Munday
- Health Services Research, Partnership for Health Analytic Research, LLC, 280 S Beverly Dr, Beverly Hills, CA 90212, USA
| | - Ann Hartry
- Health Economics and Outcomes Research, Lundbeck, 6 Parkway North, Deerfield, IL 60015, USA
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Smith MG, Royer J, Mann J, McDermott S, Valdez R. Capture-recapture methodology to study rare conditions using surveillance data for fragile X syndrome and muscular dystrophy. Orphanet J Rare Dis 2017; 12:76. [PMID: 28427448 PMCID: PMC5399384 DOI: 10.1186/s13023-017-0628-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare conditions can be catastrophic for families and the implications for public health can be substantial. Our study compared basic surveillance through active medical record review with a linked administrative data file to assess the number of cases of two rare conditions, fragile X syndrome (FXS) and muscular dystrophy (MD) in a population. METHODS Two methods of data collection were used to collect information from five counties comprising two standard metropolitan statistical areas of South Carolina. The passive system relied mostly on health claims data using ICD-9 CM diagnostic codes. The active system relied on a nurse abstracting records from a list of all licensed physicians with specialties in neurology, orthopedics, and genetics. RESULTS There were 141 FXS cases and 348 MD cases that met the case definitions using active surveillance. Additional cases were found for both conditions but they were determined to not be true cases. After linking the actively collected MD and FXS cases to passive datasets, we found that the estimated total numbers of cases were similar to using capture-recapture analysis; the positive predictive values for cases identified in the passive system were 56.6% for MD and 75.7% for FXS. CONCLUSIONS Applying capture-recapture methods to passively collected surveillance data for rare health conditions produced an estimate of the number of true cases that was similar to that obtained through active data collection.
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Affiliation(s)
- Michael G Smith
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA.
| | - Julie Royer
- Revenue and Fiscal Affairs Office, Health and Demographics Section, Columbia, SC, USA
| | - Joshua Mann
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Rodolfo Valdez
- Centers for Disease Control and Prevention, National Center for Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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Hoagwood KE, Essock S, Morrissey J, Libby A, Donahue S, Druss B, Finnerty M, Frisman L, Narasimhan M, Stein BD, Wisdom J, Zerzan J. Use of Pooled State Administrative Data for Mental Health Services Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:67-78. [PMID: 25578511 PMCID: PMC4500680 DOI: 10.1007/s10488-014-0620-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council's "The Road Ahead: Research Partnership to Transform Services," (http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals with mental disorders. The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states, and to address significant state-defined health policy initiatives. Five projects involving eight states were selected through peer review for funding. Projects began in 2009 and were funded for 3 years. This report provides a brief description of the five projects, followed by an analysis of the impact, challenges, and lessons learned from these policy-partnered studies. We conclude by offering suggestions on ways to use state administrative data for informing state health policies, which is especially timely given national and state changes in the structure and financing of healthcare.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, USA.
| | - Susan Essock
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Joseph Morrissey
- Cecil G. Sheps Center for Health Services Research, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Anne Libby
- School of Medicine, University of Colorado Health Sciences Center, Denver, USA
| | - Sheila Donahue
- New York State Office of Mental Health (OMH), Albany, USA
| | - Benjamin Druss
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Molly Finnerty
- New York State Office of Mental Health (OMH), Albany, USA.,Bureau of Evidence Based Services & Implementation Science, NYS Psychiatric Institute, New York, USA
| | - Linda Frisman
- School of Social Work, University of Connecticut, Storrs, USA
| | - Meera Narasimhan
- Department of Neuropsychiatry and Behavioral Sciences, School of Medicine, University of South Carolina, Columbia, USA
| | - Bradley D Stein
- RAND Corporation, School of Medicine, Pittsburgh, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Jennifer Wisdom
- Office of the Vice President for Research, George Washington University, Washington, USA
| | - Judy Zerzan
- Colorado Department of Health Care Policy and Financing, Denver, USA
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