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Sams DP, Garrison D, Walsh P, Maeng D, Cross W. The rapid stabilization pathway: impact of a brief inpatient intervention on the length of stay and readmissions among psychiatrically hospitalized adolescents. Child Adolesc Ment Health 2023; 28:481-487. [PMID: 36624684 DOI: 10.1111/camh.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Suicide is the second leading cause of death among adolescents in the United States (Centers for Disease Control and Prevention [CDC], 2017, Death rates due to suicide and homicide among persons age 10-24: United States, 2000-2017) constituting a significant public health crisis. The demand for psychiatric emergency services and inpatient beds is increasing, while the number of beds available decreases or remains static (National Association of State Mental Health Program Directors, 2017, Trend in psychiatric inpatient capacity, United States and Each State, 1970-2014. www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf) leading to delays in treatment and exacerbation of symptoms for some adolescents awaiting care. This pilot project describes the development, feasibility, and acceptability of a creative, values-based safety planning intervention for adolescents hospitalized on an acute inpatient psychiatric unit and the impact of this intervention on length of stay and readmissions to acute psychiatric care. METHODS Thirty patients experiencing a suicidal crisis participated in the Rapid Stabilization Pathway (RSP) during their inpatient psychiatric admission. RESULTS Results indicate that, compared to patients who underwent inpatient treatment as usual (TAU), RSP patients were discharged after a significantly shorter length of stay (4 vs. 6.1 weekdays respectively, p < .001). Further, there was no significant difference in readmission to the inpatient unit or to the psychiatric emergency room among RSP and TAU patients at 30, 60, and 90 days postdischarge. CONCLUSIONS These findings have significant implications for acute inpatient programming. The RSP intervention treated patients in a shorter amount of time without any increase in re-admissions. Further, the shortened length of stay allowed for more patients to be treated on the inpatient unit and a significant cost savings. Future directions for programming and outcome research are discussed.
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Affiliation(s)
- Deanna Palmeri Sams
- Golisano Children's Hospital at Strong, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David Garrison
- Golisano Children's Hospital at Strong, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Walsh
- Golisano Children's Hospital at Strong, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel Maeng
- Golisano Children's Hospital at Strong, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wendi Cross
- Golisano Children's Hospital at Strong, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Poleshuck E, Toscano M, Bell K, Rosenberg T, Tourtelot E, Maeng D. Predictors of referrals and depression outcomes among obstetrics and gynecology patients with positive depression screens. Fam Syst Health 2023:2024-12688-001. [PMID: 37768627 DOI: 10.1037/fsh0000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Little is known about the care provided following positive depression screens in obstetrics and gynecology (Ob/Gyn) patients. METHOD This study evaluated documented care plans and outcomes for 445 Ob/Gyn patients with positive depression screens between January 2018 and December 2020. Logistic regression models were estimated to identify predictors of changes in documented care plans and to test if a documented plan was associated with a reduction in depression severity in 6 months. RESULTS The sample consisted of 445 patients who were on average 35.5 (SD = 12.8) years; 206 (46.3%) were White and 178 (40.0%) were Black. A total of 64 (14.4%) had a depression care plan documenting antidepressant initiation or change and/or psychotherapy referral. Relative to those aged 18-29, patients 40 or older had approximately 60% lower odds of a documented care plan change (OR = 0.394; p < .05). Relative to those seen by nurses, patients seen by physicians had approximately 70% lower odds of having treatment change (OR = 0.282; p < .05). Patients with a depression care plan documented had approximately 2.7 times higher odds of achieving 50% or more reduction in their Patient Health Questionnaire-9 depression severity score than those without a documented plan (OR = 2.685; p = .009). DISCUSSION While most patients did not experience an initiation or change in their depression care plan on the same day as their positive screen, those patients with a plan documented showed significantly more improvement than those who did not. Standardized recommendations may improve depression outcomes among patients with positive depression screens. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester Medical Center
| | - Marika Toscano
- Department of Gynecology and Obstetrics, Johns Hopkins University
| | - Keisha Bell
- Department of Psychiatry, University of Rochester Medical Center
| | | | - Ellen Tourtelot
- Department of Obstetrics and Gynecology, University of Rochester Medical Center
| | - Daniel Maeng
- Department of Psychiatry, University of Rochester Medical Center
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Maeng D, Tsun ZY, Lesch E, Jacobowitz DB, Strawderman RL, Harrington DK, Li Y, Weisman RL, Lamberti JS. Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis. Psychiatr Serv 2023; 74:358-364. [PMID: 36065582 DOI: 10.1176/appi.ps.20220186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program. METHODS A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost. RESULTS The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262-$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215-$21,665), implying an ROI of 1.50 (95% CI=0.35-2.97) for FACT. CONCLUSIONS The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays.
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Affiliation(s)
- Daniel Maeng
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Zhi-Yang Tsun
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Eric Lesch
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - David B Jacobowitz
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Strawderman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Donald K Harrington
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Yue Li
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Weisman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - J Steven Lamberti
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
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Rock MC, Vaidya R, Till C, Unger JM, Hershman D, Ramsey S, Nehemiah A, Maeng D, Krouse R. Racial and Ethnic Disparity in Preference-Weighted Quality of Life: Findings from the Selenium and Vitamin E Cancer Prevention Trial. Popul Health Manag 2023. [PMID: 36625863 DOI: 10.1089/pop.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Differences in preference-weighted health-related quality of life (HRQOL) scores by race/ethnicity may be due to social factors. Here, Short-Form Six-Dimension (SF-6D) scores are analyzed among men in a prostate cancer prevention trial to explore such differences. Selenium and vitamin E cancer prevention trial participants who completed the SF-6D at baseline, and in at least 1 of follow-up years 1, 3, and 5 were included. This study compared mean SF-6D scores across race/ethnicity at each point using a linear mixed model controlling for demographic and clinical characteristics. At baseline, 9691 men were eligible for analysis, of whom 7556 (78%) were non-Hispanic White, 1592 (16.4%) were non-Hispanic Black, and 543 (5.6%) were Hispanic. Hispanic and White participants had higher unadjusted mean SF-6D scores than Black participants at every time point (P < 0.05), while white participants had lower mean scores than Hispanic participants at every time point after baseline (P < 0.05). After adjusting for covariates, statistically significant differences in HRQOL among the 3 groups persisted. Hispanic participants had higher preference scores than White participants by 0.073 (P < 0.001), 0.075 (P < 0.001), and 0.040 (P < 0.001) in follow-up years 1, 3, and 5, respectively. Black participants had lower scores than White participants by 0.009 (P = 0.004) and 0.008 (P = 0.02) in follow-up years 1 and 3, respectively. The results suggest there is a preference-weighted HRQOL difference by race/ethnicity that cannot be explained by social and clinical variables alone. Understanding how individuals belonging to different racial/ethnic categories view their own HRQOL is necessary for culturally competent care and cost-effectiveness analyses.
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Affiliation(s)
- Matthew C Rock
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Cathee Till
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Joseph M Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Dawn Hershman
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research (HICOR), Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ariel Nehemiah
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel Maeng
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert Krouse
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Choi J, Maeng D, Lee HB, Olivares T, Wittink M. Embedding Primary Care Clinic Within Community Mental Health Services Reduces All-Cause Hospitalizations and Emergency Department (ED) Visits for Patients with Severe Mental Illness (SMI) And Cardiovascular Disease (CVD). J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.10.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maeng D, Li Y, Lawrence M, Keane S, Cross W, Conner KR, Lee HB. Impact of mandatory COVID-19 shelter-in-place order on controlled substance use among rural versus urban communities in the United States. J Rural Health 2022; 39:21-29. [PMID: 35710976 PMCID: PMC9349882 DOI: 10.1111/jrh.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Mandatory COVID-19 shelter-in-place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period. METHODS Call counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per-county-per-month-per-10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations. FINDINGS During the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P = .047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P = .017) and methamphetamine (39%; P = .077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P = .069). CONCLUSION The mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities.
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Affiliation(s)
- Daniel Maeng
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Yue Li
- Division of Health Policy and Outcomes ResearchDepartment of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michele Lawrence
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinead Keane
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wendi Cross
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth R. Conner
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hochang B. Lee
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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7
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Li Y, Cheng Z, Cai X, Holloway M, Maeng D, Simning A. Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5694. [PMID: 35170782 PMCID: PMC8884256 DOI: 10.1002/gps.5694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance. RESULTS The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided. CONCLUSIONS Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.
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Affiliation(s)
- Yue Li
- Department of Public Health SciencesDivision of Health Policy and Outcomes ResearchUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Zijing Cheng
- Department of Public Health SciencesDivision of Health Policy and Outcomes ResearchUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Xueya Cai
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Melissa Holloway
- University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Daniel Maeng
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Adam Simning
- Department of PsychiatryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Johnson KA, Hunt T, Puglisi LB, Maeng D, Epa-Llop A, Elumn JE, Nguyen A, Leung A, Chen R, Shah Z, Wang J, Johnson R, Chapman BP, Gilbert L, El-Bassel N, Morse DS. Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration. Front Psychiatry 2022; 13:867445. [PMID: 35693964 PMCID: PMC9186377 DOI: 10.3389/fpsyt.2022.867445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND U.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention. METHODS We examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority. RESULTS PTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722). CONCLUSION Given the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.
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Affiliation(s)
- Karen A Johnson
- University of Alabama School of Social Work, Tuscaloosa, AL, United States
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Lisa B Puglisi
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Daniel Maeng
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Amali Epa-Llop
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Johanna E Elumn
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Antoinette Nguyen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Ashley Leung
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Chen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Zainab Shah
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Jiayi Wang
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Johnson
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Diane S Morse
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.,Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
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Rock M, Vaidya R, Till C, Unger JM, Hershman DL, Maeng D, Krouse RS. Preference-weighted quality of life: Findings from the Selenium and Vitamin E Cancer Prevention Trial (SELECT). J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
144 Background: The differences in preference-weighted health-related quality of life (HRQOL) among racial and ethnic groups have been previously reported. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) enrolled 35,533 men aged 50 years and older, among whom 20% were minorities. HRQOL, using the SF-36V, was examined for a subset of participants. Using these survey data, we examined the preference-weighted HRQOL differences across the racial/ethnic categories included in SELECT. Methods: SELECT participants who completed the SF-36V at baseline, and subsequently in at least one of years 1, 3, and 5 were included. We used the SF-6D to calculate an HRQOL score ranging between 0 (worst possible) and 1 (best possible) for every participant using data from the SF-36V. We modeled the association of race/ethnicity with SF-6D scores using a linear mixed model adjusting for demographic and clinical characteristics. Results: At baseline, 9,691 men were eligible for analysis. Hispanic and non-Hispanic white participants had higher unadjusted mean SF-6D scores than non-Hispanic Black participants at baseline and every subsequent time point (p<0.05; Table). Non-Hispanic white participants had lower mean scores than Hispanic participants at every time point after baseline. After adjusting for demographic and clinical characteristics there are statistically significant differences in HRQOL among all three groups. In particular, Hispanic participants had higher scores than white participants by.074 (p<.001),.076 (p<.001), and.039 (p<.001) in years 1, 3, and 5 after baseline. Conversely, compared to non-Hispanic White participants, non-Hispanic Black participants had lower scores by.009 (p=.004) and.008 (p=.02) in years 1 and 3 after baseline. Conclusions: In this sample of men enrolled in a prostate cancer chemoprevention trial, preference-weighted HRQOL using the SF-6D was higher for Hispanic men than for white and Black men, and lower for Black men than for white men. Understanding how individuals belonging to different racial and/or ethnic categories view their own HRQOL is necessary not only for delivering culturally competent care but also for conducting accurate cost effectiveness analyses of new interventions and programs. Further research that includes a sample with women, reports on more categories of race/ethnicity, and explores underlying potential cultural and social differences is necessary. [Table: see text]
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Affiliation(s)
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Seattle, WA
| | - Cathee Till
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Daniel Maeng
- University of Rochester Medical Center, Rochester, NY
| | - Robert S. Krouse
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Maeng D, Cornell AE, Nasra GS. Employer-sponsored behavioral health program impacts on care utilization and cost. Am J Manag Care 2021; 27:334-339. [PMID: 34460175 DOI: 10.37765/ajmc.2021.88724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To examine the impact of an employer-sponsored behavioral health (BH) program on all-cause health care utilization and cost. STUDY DESIGN Retrospective analysis of health insurance claims data obtained from a large employer in western New York covering a 25-month period between 2016 and 2018. Those employees treated by the employer-sponsored BH program were compared against a contemporaneous comparison group of employees of the same employer who had eligible BH diagnoses for the program but were treated elsewhere. METHODS A difference-in-differences method was used to estimate the program's impact on all-cause care utilization (physician office visits and acute care utilization) and total cost of care, including prescription drug costs. RESULTS Program participation was associated with a reduction of approximately 28% in total cost of care including prescription drug costs (P = .043) over an 18-month period following the initial program encounter, as well as 27% reductions in primary care provider (PCP) visits (P = .001) and non-BH specialist visits (P = .005). No significant impacts were observed for acute care utilization and BH specialist visit rates. CONCLUSIONS The results suggest that the employer-sponsored BH program implementation may have shifted treatments of certain BH conditions away from PCPs and non-BH specialists who may not have the proper training or resources to manage such conditions. Therefore, these results are consistent with the expectation that improved access to BH care is likely to improve efficiency in the health care system via provision of more appropriate care for those who need it.
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Affiliation(s)
- Daniel Maeng
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Box PSYCH, Rochester, NY 14642.
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11
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Maeng D, Richman JH, Lee HB, Hasselberg MJ. Impact of integrating psychiatric assessment officers via telepsychiatry on rural hospitals' emergency revisit rates. J Psychosom Res 2020; 133:109997. [PMID: 32220648 DOI: 10.1016/j.jpsychores.2020.109997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the impact of integrating Psychiatric Assessment Officers (PAO) and telepsychiatry in rural hospitals on their all-cause emergency department (ED) revisit rates. As a pilot project, a full-time PAO was embedded in each of three rural hospitals in New York State and was augmented by telepsychiatry. METHOD A retrospective data analysis using ED census data obtained from the hospitals. The intervention group, defined as those patients treated by PAOs, was compared via a difference-in-difference method against a contemporaneous comparison group defined as those who visited the same EDs and had PAO-qualifying behavioral health diagnoses but were not seen by PAOs. RESULTS The intervention group was associated with an approximately 36% lower all-cause ED revisit rate during the first 90-day period (i.e. 1-90 days) following the initial PAO treatment (p = .003). A reduction of the similar magnitude (44%) persisted into the subsequent 90-day period (i.e., 91-180 days since the initial PAO treatment; p < .001). CONCLUSION The PAO telepsychiatry pilot program suggests a potential way to provide relief for overburdened EDs in rural communities that lack resources to treat patients with severe behavioral health symptoms.
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Affiliation(s)
- Daniel Maeng
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - Jennifer H Richman
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - H Benjamin Lee
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - Michael J Hasselberg
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
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12
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Maeng D, Wall B, Hassen D, Diehl DL. Upstream and downstream revenue of upper gastrointestinal endoscopic ultrasound determined with an episode-of-care approach. Endosc Int Open 2019; 7:E1316-E1321. [PMID: 31673600 PMCID: PMC6805194 DOI: 10.1055/a-0990-9458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023] Open
Abstract
Background and study aims Upper gastrointestinal endoscopic ultrasound (EUS) has clinical advantages that can lead to improved patient outcome. This study seeks to characterize and quantify the upstream and downstream healthcare utilizations and revenues. Patients and methods A retrospective claims data analysis of upper gastrointestinal EUS procedures was conducted at a large health system. Types of care and total revenues associated with each episode of care were characterized by descriptive statistics. Comparisons were made between patients who had Medicare Advantage and commercial plans as well as those with and without cancer diagnoses during the downstream period. Results A total of 436 cases were identified. The most frequent downstream healthcare utilizations consisted of radiology (31 %), pathology services (28 %), and high-revenue services including chemotherapy and inpatient admissions. The most common upstream utilizations included radiology (18 %) and lab services (22 %). Average total downstream revenue was $ 34 231 (95 %CI: $ 28 561 - $ 39 901) per case, and average total upstream revenue was $4373 (95 %CI: $3227 - $ 5519). Average total revenue per case did not differ significantly between Medicare Advantage and commercial plan members. However, patients who were diagnosed with cancer at or immediately following EUS (20 %) were associated with significantly higher total revenue compared to those without cancer diagnosis ( P < 0.0001). Conclusions This episode-of-care approach to quantifying the revenue impact of upper gastrointestinal EUS to the providers suggests there are substantial downstream as well as upstream revenues associated with upper gastrointestinal EUS procedures, driven by patients who are diagnosed with cancer by the EUS procedures and subsequently require oncologic care.
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Affiliation(s)
- Daniel Maeng
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
| | - Beth Wall
- Olympus Corporation of the Americas, Center Valley, PA, USA
| | - Dina Hassen
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA,Corresponding author Dina Hassen, MPP 100 N. Academy AveDanvillePA 17822USA+1-570-214-9451
| | - David L. Diehl
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
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Geng Z, Maeng D. Impact of Employee Wellness Program on Health Outcome: A Propensity Score-Matched Analysis. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Maeng D, Geng Z. Impact of a Biometric Screening and Premium Incentive-Based Employee Wellness Program on Cost of Care and Utilization. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Geng Z, Maeng D. Factors Associated With Participations and Goals Achievement in an Employee Wellness Program Offering Biometric Screenings and Premium Discounts. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Maeng D, Pitcavage J, Rohrer G, Bulger J. Value of Physician Performance in Diabetes System of Care Among Elderly Medicare Patients: Implications for Pay-for-Performance. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Christianson J, Maeng D, Abraham J, Scanlon DP, Alexander J, Mittler J, Finch M. What influences the awareness of physician quality information? Implications for Medicare. Medicare Medicaid Res Rev 2014; 4:mmrr2014.004.02.a02. [PMID: 24949225 DOI: 10.5600/mmrr.004.02.a02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Examine the factors that are associated with awareness of physician quality information (PQI) among older people with one or more chronic illnesses and the implications for Medicare. DATA SOURCES/STUDY SETTING Random digit-dial survey of adults with one or more chronic illnesses. RESEARCH DESIGN Structural equation modeling to examine factors related to awareness of PQI. RESULTS Awareness of PQI is low (13 percent), but comparable to findings in general population surveys. Age, race, education, and self-reported health status are associated with PQI awareness. Trust in the Internet as a source of health care information and not trusting one's physician as a source of information both are associated with a greater likelihood of being aware of PQI. Patients with high levels of activation have greater trust in physicians as information sources, but this is not associated with awareness, nor is degree of satisfaction with their care experience. CONCLUSIONS Awareness of PQI among older persons with chronic illnesses is relatively low across all socio-economic and demographic subgroups. Changes in population characteristics over time are unlikely to improve awareness in this population, nor are changes in patient activation or satisfaction with care. Medicare would need a broad-based effort if it wishes to raise PQI awareness among Medicare beneficiaries in the near term. Before undertaking resource-intensive efforts to increase awareness, Medicare may want to consider what level of awareness actually is needed to accomplish the overall objective for PQI transparency, which is raising the quality of care received by beneficiaries. It may be that relatively low levels of awareness are sufficient.
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Affiliation(s)
- Jon Christianson
- University of Minnesota School of Public Health-Division of Health Policy and Management
| | - Daniel Maeng
- Geisinger Health System-Center for Health Research
| | - Jean Abraham
- University of Minnesota School of Public Health-Division of Health Policy and Management
| | - Dennis P Scanlon
- The Pennsylvania State University-Department of Health Policy & Administration
| | | | - Jessica Mittler
- The Pennsylvania State University-Department of Health Policy & Administration
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Alexander JA, Maeng D, Casalino LP, Rittenhouse D. Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter? Health Serv Res 2012; 48:376-97. [PMID: 22880957 DOI: 10.1111/j.1475-6773.2012.01454.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups. DATA Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR. STUDY DESIGN We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate. FINDINGS (1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone. CONCLUSION Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting.
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Affiliation(s)
- Jeffrey A Alexander
- Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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