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Nawaz S, Moon KJ, Hasenstab KA, Bryant I, Singh P, Montesano VL, Knudsen K, Wastler HM, Blouin A, Breitborde NJK, Seiber EE. Costs of Coordinated Specialty Care for First-Episode Psychosis: A Microcosting Analysis. Psychiatr Serv 2024; 75:295-298. [PMID: 37731346 DOI: 10.1176/appi.ps.20230241] [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] [Indexed: 09/22/2023]
Abstract
In this study, the authors measured and described the costs of coordinated specialty care (CSC) for first-episode psychosis in Ohio. A microcosting tool was used to estimate personnel and nonpersonnel costs of service delivery at seven CSC programs. Average annual cost per participant (N=511 participants) was estimated as $17,810 (95% CI=$9,141-$26,479). On average, 61% (95% CI=53%-69%) of annual program costs were nonbillable. Key cost drivers included facility costs, administrative tasks, and social services. Novel financing models may redress reimbursement gaps incurred by CSC programs.
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Affiliation(s)
- Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Parvati Singh
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Vicki L Montesano
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kraig Knudsen
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Heather M Wastler
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Alexandra Blouin
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Nicholas J K Breitborde
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
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Singh P, Nawaz S, Seiber EE, Bryant I, Moon K, Wastler H, Breitborde NJ. ED Visits for Schizophrenia Spectrum Disorders During the COVID-19 Pandemic at 5 Campus Health Systems. JAMA Netw Open 2023; 6:e2349305. [PMID: 38150255 PMCID: PMC10753394 DOI: 10.1001/jamanetworkopen.2023.49305] [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] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Although substantial research has reported grave population-level psychiatric sequelae of the COVID-19 pandemic, evidence pertaining to temporal changes in schizophrenia spectrum disorders in the US following the pandemic remains limited. Objective To examine the monthly patterns of emergency department (ED) visits for schizophrenia spectrum disorders after the onset of the COVID-19 pandemic. Design, Setting, and Participants This observational cohort study used time-series analyses to examine whether monthly counts of ED visits for schizophrenia spectrum disorders across 5 University of California (UC) campus health systems increased beyond expected levels during the COVID-19 pandemic. Data included ED visits reported by the 5 UC campuses from 2016 to 2021. Participants included persons who accessed UC Health System EDs had a diagnosis of a psychiatric condition. Data analysis was performed from March to June 2023. Exposures The exposures were binary indicators of initial (March to May 2020) and extended (March to December 2020) phases of the COVID-19 pandemic. Main Outcomes and Measures The primary outcome was monthly counts of ED visits for schizophrenia spectrum disorders. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes, categorized within Clinical Classification Software groups, were used to identify ED visits for schizophrenia spectrum disorders and all other psychiatric ED visits, from the University of California Health Data Warehouse database, from January 2016 to December 2021. Time-series analyses controlled for autocorrelation, seasonality, and concurrent trends in ED visits for all other psychiatric conditions. Results The study data comprised a total of 377 872 psychiatric ED visits, with 37 815 visits for schizophrenia spectrum disorders. The prepandemic monthly mean (SD) number of ED visits for schizophrenia spectrum disorders was 519.9 (38.1), which increased to 558.4 (47.6) following the onset of the COVID-19 pandemic. Results from time series analyses, controlling for monthly counts of ED visits for all other psychiatric conditions, indicated 70.5 additional ED visits (95% CI, 11.7-129.3 additional visits; P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (95% CI, 24.0-126.0 visits; P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California. Conclusions and Relevance This study found a 15% increase in ED visits for schizophrenia spectrum disorders within 3 months after the initial phase of the pandemic in California across 5 UC campus health systems, underscoring the importance of social policies related to future emergency preparedness and the need to strengthen mental health care systems.
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Affiliation(s)
- Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Eric E. Seiber
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Ian Bryant
- Department of Economics, University of Cincinnati, Cincinnati, Ohio
| | - Kyle Moon
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus
| | - Heather Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
| | - Nicholas J. Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
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Moon KJ, Hasenstab KA, Bryant I, Chang LV, Seiber EE, Norris AH, Nawaz S. Service trends among non-obstetrics/gynecology providers in the U.S.: Long-acting reversible contraception insertions, removals, and re-insertions. Sex Reprod Healthc 2023; 38:100919. [PMID: 37839215 DOI: 10.1016/j.srhc.2023.100919] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
This study evaluates trends in long-acting reversible contraception (LARC) services among obstetrician/gynecologists (OB/GYNs) and non-OB/GYNs in the U.S. during 2012-2018. Using public and private insurance claims from the Symphony Health database, we calculated the percentage of LARC insertions, removals, and reinsertions performed by OB/GYNs and non-OB/GYNs. We then assessed time trends with linear regression. The proportion of LARC services that were performed by non-OBGYNs increased modestly between 2012 and 2018. Increases were similar for insertions, removals, and reinsertions. Further research is needed to understand trends in LARC service provision within primary care to better tailor medical training and policy interventions.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Department of Economics, University of Cincinnati Linder College of Business, Cincinnati, OH, USA
| | - Lenisa V Chang
- Department of Economics, University of Cincinnati Linder College of Business, Cincinnati, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Alison H Norris
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH, USA; Division of Infectious Diseases, Ohio State University College of Medicine, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Moon KJ, Bryant I, Trinh A, Hasenstab KA, Carter B, Barclay R, Nawaz S. Differential risks of syringe service program participants in Central Ohio: a latent class analysis. Harm Reduct J 2023; 20:97. [PMID: 37507721 PMCID: PMC10386257 DOI: 10.1186/s12954-023-00824-8] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Significant heterogeneity exists among people who use drugs (PWUD). We identify distinct profiles of syringe service program (SSP) clients to (a) evaluate differential risk factors across subgroups and (b) inform harm reduction programming. METHODS Latent class analysis (LCA) was applied to identify subgroups of participants (N = 3418) in a SSP in Columbus, Ohio, from 2019 to 2021. Demographics (age, sex, race/ethnicity, sexual orientation, housing status) and drug use characteristics (substance[s] used, syringe gauge, needle length, using alone, mixing drugs, sharing supplies, reducing use, self-reported perceptions on the impact of use, and treatment/support resources) were used as indicators to define latent classes. A five-class LCA model was developed, and logistic regression was then employed to compare risk factors at program initiation and at follow-up visits between latent classes. RESULTS Five latent classes were identified: (1) heterosexual males using opioids/stimulants with housing instability and limited resources for treatment/support (16.1%), (2) heterosexual individuals using opioids with stable housing and resources for treatment/support (33.1%), (3) individuals using methamphetamine (12.4%), (4) young white individuals using opioids/methamphetamine (20.5%), and (5) females using opioids/cocaine (17.9%). Class 2 served as the reference group for logistic regression models, and at the time of entry, class 1 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs, with persistently higher odds of sharing supplies and mixing drugs at follow-up. Class 3 was more likely to report history of overdose, sharing supplies, and mixing drugs, but outcomes at follow-up were comparable. Class 4 was the least likely to report history of overdose, HCV, and mixing drugs, but the most likely to report HIV. Class 5 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs at entry, and higher reports of accessing substance use treatment and testing positive for HCV persisted at follow-up. CONCLUSIONS Considerable heterogeneity exists among PWUD, leading to differential risk factors that may persist throughout engagement in harm reduction services. LCA can identify distinct profiles of PWUD accessing services to tailor interventions that address risks, improve outcomes, and mitigate disparities.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | | | | | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA.
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