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Compton MT, Frimpong EY, Ehntholt A, Zhu H, Chaudhry S, Ferdousi W, Rowan GA, Radigan M, Smith TE, Rotter M. Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses. Community Ment Health J 2024; 60:251-258. [PMID: 37395820 DOI: 10.1007/s10597-023-01165-3] [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] [Received: 11/28/2022] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | | | - Amy Ehntholt
- New York State Psychiatric Institute, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Huilin Zhu
- New York State Office of Mental Health, Albany, NY, USA
| | | | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, NY, USA
| | | | - Thomas E Smith
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Merrill Rotter
- New York State Office of Mental Health, Albany, NY, USA
- Albert Einstein College of Medicine, New York, NY, USA
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Compton MT, Frimpong EY, Fu E, Ehntholt A, Chaudhry S, Ferdousi W, Rowan GA, Swetnam H, Radigan M, Smith TE, Rotter M. Associations Between Cumulative Social Adversities and Substance Use Comorbidity in a Statewide Sample of Individuals in Treatment for Mental Illnesses. J Nerv Ment Dis 2023; 211:814-818. [PMID: 37552046 DOI: 10.1097/nmd.0000000000001703] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
ABSTRACT We sought to investigate associations of cumulative social adversities in four areas (low education, unemployment, homelessness, and criminal/legal involvement) with presence of comorbid alcohol and drug use disorders among individuals in treatment for mental illnesses. Using data from 103,416 adults in mental health treatment, generalized estimating equation modified Poisson models were used to estimate increased risk of having comorbid substance use disorders based on individual and/or cumulative number of social adversities present. Controlling for effects of sex, race/ethnicity, and region (New York City vs . the rest of the State), as well as for the other social adversities, each of four social adversities was associated with presence of substance use comorbidity. Relative to having none of the social adversities, the presence of one, two, three, or four was associated with an increased prevalence ratio (PR) of having substance use comorbidity: 1.44, 2.10, 2.66, and 2.92; all p 's < 0.0001. PRs were greater among female patients, and among Hispanics and those classified as other or multiracial compared with non-Hispanic Whites or non-Hispanic Blacks. Findings indicate substantial associations between four social adversities and presence of substance use comorbidity; the strength of association with the four social adversities is cumulative.
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Affiliation(s)
| | | | - En Fu
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Sahil Chaudhry
- New York State Office of Mental Health, Albany, New York
| | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, New York
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany, New York
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Frimpong EY, Ferdousi W, Rowan GA, Chaudhry S, Swetnam H, Compton MT, Smith TE, Radigan M. Racial and Ethnic Disparities in Health Care Access and Utilization among Medicaid Managed Care Beneficiaries. J Behav Health Serv Res 2023; 50:194-213. [PMID: 35945481 DOI: 10.1007/s11414-022-09811-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
This quasi-experimental study examined the impact of a statewide integrated special needs program Health and Recovery Plan (HARP) for individuals with serious mental illness and identified racial and ethnic disparities in access to Medicaid services. Generalized estimating equation negative binomial models were used to estimate changes in service use, difference-in-differences, and difference-in-difference-in-differences in the pre- to post-HARP periods. Implementation of the special needs plan contributed to reductions in racial/ethnic disparities in access and utilization. Notable among those enrolled in the special needs plan was the declining Black-White disparities in emergency room (ER) visits and inpatient stays, but the disparity in non-behavioral health clinic visits remains. Also, the decline of Hispanic-White disparities in ER, inpatient, and clinic use was more evident for HARP-enrolled patients. Health equity policies are needed in the delivery of care to linguistically and culturally disadvantaged Medicaid beneficiaries.
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Affiliation(s)
| | | | - Grace A Rowan
- New York State Office of Mental Health, New York, NY, USA
| | - Sahil Chaudhry
- New York State Office of Mental Health, New York, NY, USA
| | - Hannah Swetnam
- New York State Office of Mental Health, New York, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Thomas E Smith
- New York State Office of Mental Health, New York, NY, USA.,Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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Ehntholt A, Frimpong EY, Compton MT, Rowan GA, Ferdousi W, Swetnam H, Chaudhry S, Radigan M, Smith TE, Rotter M. Prevalence and Correlates of Four Social Determinants in a Statewide Survey of Licensed Mental Health Services. Psychiatr Serv 2022; 73:1282-1285. [PMID: 35538747 DOI: 10.1176/appi.ps.202100380] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics. METHODS With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence. RESULTS High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants. CONCLUSIONS Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.
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Affiliation(s)
- Amy Ehntholt
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Eric Y Frimpong
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Michael T Compton
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Grace A Rowan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Wahida Ferdousi
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Sahil Chaudhry
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Marleen Radigan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Thomas E Smith
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Merrill Rotter
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
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Rowan GA, Frimpong EY, Li M, Chaudhry S, Radigan M. Health Disparities Between Older Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the Public Mental Health System. Psychiatr Serv 2022; 73:39-45. [PMID: 34320831 DOI: 10.1176/appi.ps.202000940] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors examined disparities in general health, substance use, mental health conditions, and acute service use between lesbian, gay, and bisexual (LGB) adults (ages ≥50 years) and a matched sample of heterosexual adults. METHODS Individuals whose electronic health record indicated their sexual orientation as gay, lesbian, or bisexual from the 2015 New York State Office of Mental Health Patient Characteristics Survey were matched with heterosexual individuals, resulting in N=1,659 individuals in each of the two groups. Differences in health status indicators and acute service use were compared in generalized estimating equation models. RESULTS Compared with matched heterosexual men, older gay and bisexual men had more chronic general medical conditions and mental health issues; they also had fewer inpatient stays related to substance use disorders. Older lesbian and bisexual women had higher rates of tobacco use, alcohol use, and substance use disorders than heterosexual women; moreover, they reported more inpatient stays and emergency department visits related to substance use disorders. CONCLUSIONS This study provides evidence of health disparities among sexual minority older adults within a public mental health system. The results suggest that health disparities persist into older adulthood and that new health concerns emerge with the aging of the sexual minority population. Targeted prevention and intervention programs are needed to effectively engage older LGB adults into treatment for general medical and mental illnesses as well as substance use disorders.
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Affiliation(s)
| | | | - Mengxuan Li
- New York State Office of Mental Health, Albany
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Frimpong EY, Ferdousi W, Rowan GA, Radigan M. Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State. Health Serv Res 2021; 56:677-690. [PMID: 33876432 DOI: 10.1111/1475-6773.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the Health and Recovery Plan (HARP), a capitated special needs Medicaid managed care product that fully integrates physical and behavioral health delivery systems in New York State. DATA SOURCES 2013-2019 claims and encounters data on continuously enrolled individuals from the New York State Medicaid data system. STUDY DESIGN We used a difference-in-difference approach with inverse probability of exposure weights to compare service use outcomes in individuals enrolled in the HARP versus HARP eligible comparison group in two regions, New York City (NYC) pre- (2013-2015) versus post- (2016-2018) intervention periods, and rest of the state (ROS) pre- (2014-2016) versus post- (2017-2019) intervention periods. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS HARPs were associated with a relative decrease in all-cause (RR = 0.78, 95% CI 0.68-0.90), behavioral health-related (RR = 0.76, 95% CI 0.60-0.96), and nonbehavioral-related (RR = 0.87, 95% CI 0.78-0.97) stays in the NYC region. In the ROS region, HARPs were associated with a relative decrease in all-cause (RR = 0.87, 95% CI 0.80-0.94) and behavioral health-related (RR = 0.80, 95% CI 0.70-0.91) stays. Regarding outpatient visits, the HARPs benefit package were associated with a relative increase in behavioral health (RR = 1.21, 95% CI 1.13-1.28) and nonbehavioral health (RR = 1.08, 95% CI 1.01-1.15) clinic visits in the NYC region. In the ROS region, the HARPs were associated with relative increases in behavioral health (RR = 1.47, 95% CI 1.32-1.64) and nonbehavioral health (RR = 1.17, 95% CI 1.11-1.25) clinic visits. CONCLUSIONS Compared to patients with similar clinical needs, HARPs were associated with a relative increase in services used and led to a better engagement in the HARPs group regardless of the overall decline in services used pre- to postperiod.
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Affiliation(s)
- Eric Y Frimpong
- New York State Office of Mental Health, Albany, New York, USA
| | - Wahida Ferdousi
- New York State Office of Mental Health, Albany, New York, USA
| | - Grace A Rowan
- New York State Office of Mental Health, Albany, New York, USA
| | - Marleen Radigan
- New York State Office of Mental Health, Albany, New York, USA
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Frimpong EY, Rowan GA, Williams D, Li M, Solano L, Chaudhry S, Radigan M. Health Disparities, Inpatient Stays, and Emergency Room Visits Among Lesbian, Gay, and Bisexual People: Evidence From a Mental Health System. Psychiatr Serv 2020; 71:128-135. [PMID: 31590623 DOI: 10.1176/appi.ps.201900188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined differences in health outcomes and acute service use between lesbian, gay, and bisexual (LGB) individuals and a matched heterosexual control group. METHODS Individuals ages 18 to 85 whose electronic health records indicated a sexual orientation as LGB and who were included in the 2015 New York State Office of Mental Health Patient Characteristics Survey (N=5,775) were matched with heterosexuals (N=5,775) by sex assigned at birth, age, race, Hispanic ethnicity, and county of residence and compared on health status indicators, conditions and behaviors, and acute service use. Generalized estimating equation models were used to estimate the odds and rates of acute service use. RESULTS LGB individuals appeared to have more chronic general medical conditions and physical disabilities and tended to use fewer acute services compared with heterosexuals. Gay men and lesbians were significantly less likely than heterosexuals to have used a mental health-related inpatient service (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]=0.57-0.85; and AOR=0.73, 95% CI=0.59-0.89 [respectively]) or emergency room (ER) service in the past 12 months (AOR=0.63, 95% CI=0.53-0.76; and AOR=0.79, 95% CI=0.66-0.94 [respectively]). Bisexual men and women were more likely than heterosexuals to have shorter substance use-related inpatient stays (rate ratio [RR]=0.65, 95% CI=0.47-0.90; and RR=0.66, 95% CI=0.51-0.86 [respectively]) and to have fewer substance use-related ER visits (RR=0.69, 95% CI=0.48-0.99; and RR=0.55, 95% CI=0.43-0.69 [respectively]). CONCLUSIONS The health care system needs strategies in LGB-centered care, research, medical education, health policy, and evidence-based practices to engage sexual minority groups in mental health and general medical care.
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Affiliation(s)
- Eric Y Frimpong
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Grace A Rowan
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - David Williams
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Mengxuan Li
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Louis Solano
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Sahil Chaudhry
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Marleen Radigan
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
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Radigan M, Gu G, Frimpong EY, Wang R, Huz S, Li M, Nossel I, Dixon L. A New Method for Estimating Incidence of First Psychotic Diagnosis in a Medicaid Population. Psychiatr Serv 2019; 70:665-673. [PMID: 31138057 DOI: 10.1176/appi.ps.201900033] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early intervention programs for first-episode psychosis (FEP) require population-based methods to identify individuals with FEP. This study adapted a previously published method to estimate incidence of first psychotic diagnosis in a state Medicaid program. Secondary aims were to examine demographic and service patterns associated with a first psychotic diagnosis in Medicaid. METHODS A retrospective, population-based study of New York State Medicaid data was conducted to identify first occurrence of psychotic diagnosis among persons ages 15-35 between January 1, 2013, and December 31, 2017 (N=31,606). Age-stratified incidence rates (IRs) were calculated by demographic characteristics, first-diagnosis type, and service-related characteristics. Review of charts from OnTrackNY and Medicaid managed care organizations (MCOs) was conducted to confirm identified cases. Initial IRs and confirmation rates were used to estimate adjusted IRs. RESULTS Age-stratified IRs varied by demographic, diagnostic, and service-related characteristic. IRs of FEP were higher for persons ages 15 to 25 relative to persons ages 26-35 if the first provider was an acute behavioral health emergency or inpatient setting (rate ratio=1.286; 95% confidence interval=1.24-1.33). Case confirmation rates were 90% for OnTrack NY and 53% for the MCOs. Adjusted annual IR of first diagnosis of psychosis was 272 per 100,000. CONCLUSIONS Incidence of first psychotic diagnosis in this Medicaid population was higher than previously found in insured populations. Future work will focus on algorithm refinements and piloting outreach. Administrative data algorithms may be useful to providers, Medicaid MCOs, and state Medicaid authorities to support case finding and early intervention.
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Affiliation(s)
- Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Gyojeong Gu
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Eric Y Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Steven Huz
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Mengxuan Li
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Ilana Nossel
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
| | - Lisa Dixon
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Frimpong, Wang, Huz, Li); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Nossel, Dixon)
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Frimpong EY, Kuang J, Wang R, Radigan M. Medicaid Cost Trajectories for Children With Serious Emotional Disturbance: The HCBS Waiver Program Versus Targeted Case Management. Psychiatr Serv 2018; 69:1160-1166. [PMID: 30152274 DOI: 10.1176/appi.ps.201700537] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study compared Medicaid cost-effectiveness for children with serious emotional disturbance receiving services from two programs operated by the New York State Office of Mental Health: the Home and Community-Based Services (HCBS) Waiver program and targeted case management (TCM). METHODS Children ages four to 18 who received services from the HCBS Waiver program (N=1,602) or TCM (N=2,740) during 2009-2012 were selected. A quasi-experimental study design with propensity score-matched comparison groups was used to examine Medicaid costs (per member per month [PMPM] total cost) before admission to and after discharge from the HCBS Waiver and TCM programs. Exponential smoothing models were used to examine Medicaid cost trends before and after each program. Difference-in-difference techniques were used to estimate the average annual difference in PMPM Medicaid cost. RESULTS Trends for PMPM total Medicaid cost for HCBS Waiver-enrolled children after discharge decreased by 25%, whereas postdischarge costs for TCM-enrolled children increased by 15%. The adjusted pre-to-post difference in PMPM total Medicaid cost for HCBS Waiver children decreased by $498 and increased for TCM children by $448-a statistically significant decline of $946 (range $927-$963) in average PMPM Medicaid cost for HCBS Waiver children compared with TCM children. CONCLUSIONS The PMPM Medicaid cost for children during HCBS Waiver enrollment was higher than for similar children enrolled in TCM. However, Medicaid cost savings for the HCBS Waiver group after the program may support investment in the more intensive HCBS Waiver program for children with comparable psychiatric needs.
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Affiliation(s)
- Eric Y Frimpong
- Dr. Frimpong, Ms. Wang, and Dr. Radigan are with the New York State Office of Mental Health, Albany. Ms. Kuang is with the New York State Department of Health, Albany
| | - Jiankun Kuang
- Dr. Frimpong, Ms. Wang, and Dr. Radigan are with the New York State Office of Mental Health, Albany. Ms. Kuang is with the New York State Department of Health, Albany
| | - Rui Wang
- Dr. Frimpong, Ms. Wang, and Dr. Radigan are with the New York State Office of Mental Health, Albany. Ms. Kuang is with the New York State Department of Health, Albany
| | - Marleen Radigan
- Dr. Frimpong, Ms. Wang, and Dr. Radigan are with the New York State Office of Mental Health, Albany. Ms. Kuang is with the New York State Department of Health, Albany
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Carruthers J, Radigan M, Erlich MD, Gu G, Wang R, Frimpong EY, Essock SM, Olfson M, Castillo EG, Miller GA, Sederer LI, Stroup TS. An Initiative to Improve Clozapine Prescribing in New York State. Psychiatr Serv 2016; 67:369-71. [PMID: 26725299 DOI: 10.1176/appi.ps.201500493] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 11/30/2022]
Abstract
Clozapine remains the only medication approved for treatment-resistant schizophrenia. But underuse is the norm. In 2010, the New York State Office of Mental Health began a multifaceted initiative to promote the evidence-based use of clozapine. From 2009 to 2013, in the absence of a well-funded pharmaceutical marketing campaign, the proportion of new clozapine trials among all new outpatient antipsychotic trials increased 40% among adult New York Medicaid recipients with a diagnosis of schizophrenia. The largest gains occurred in state-operated clinics. New York's experience demonstrates the feasibility of making clozapine more accessible to patients who stand to benefit most.
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Affiliation(s)
- Jay Carruthers
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Marleen Radigan
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Matthew D Erlich
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Gyojeong Gu
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Rui Wang
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Eric Y Frimpong
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Susan M Essock
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Mark Olfson
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Enrico G Castillo
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Gregory A Miller
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Lloyd I Sederer
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - T Scott Stroup
- Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
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11
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Abstract
While randomized controlled trials may not be considered efficient for investigating rare adverse events based on their size, biases associated with other epidemiological designs may justify the additional resources. In certain contexts it may be appropriate, for example, to inflate the noninferiority (NI) margin to decrease the sample size, provided the excess risk that will be ruled out remains clinically relevant. The implication of a reduced sample size on the number of events anticipated from the trial is often not considered at the study design phase but may have important ramifications. To assess the implications of modifying study design parameters, approximations are presented for (a) how likely it is that no events will be observed, (b) how many events should be anticipated, and (c) how likely it is that v or more events will be observed. The approximations presented are intended to serve as tangible a priori expectations from the study. This work is motivated from an FDA Advisory Committee meeting regarding a discussion at the association between long-acting beta-agonists and asthma-related deaths.
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Affiliation(s)
- Bradley W McEvoy
- Center for Drug Evaluation and Research Office of Biostatistics, Food and Drug Administration, Silver Spring, Maryland 20993-0002, USA.
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Margulis AV, Abou-Ali A, Strazzeri MM, Ding Y, Kuyateh F, Frimpong EY, Levenson MS, Hammad TA. Use of selective serotonin reuptake inhibitors in pregnancy and cardiac malformations: a propensity-score matched cohort in CPRD. Pharmacoepidemiol Drug Saf 2013; 22:942-51. [DOI: 10.1002/pds.3462] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/31/2013] [Accepted: 04/22/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Andrea V. Margulis
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Adel Abou-Ali
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Marian M. Strazzeri
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Yulan Ding
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Fatmatta Kuyateh
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Eric Y. Frimpong
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Mark S. Levenson
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
| | - Tarek A. Hammad
- US Food and Drug Administration; 10903 New Hampshire Avenue Silver Spring MD 20993 USA
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