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Chuang E, Safaeinili N. Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care. Annu Rev Public Health 2024; 45:443-464. [PMID: 38134403 DOI: 10.1146/annurev-publhealth-061022-050026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
In recent years, health care policy makers have focused increasingly on addressing social drivers of health as a strategy for improving health and health equity. Impacts of social, economic, and environmental conditions on health are well established. However, less is known about the implementation and impact of approaches used by health care providers and payers to address social drivers of health in clinical settings. This article reviews current efforts by US health care organizations and public payers such as Medicaid and Medicare to address social drivers of health at the individual and community levels. We summarize the limited available evidence regarding intervention impacts on health care utilization, costs, and integration of care and identify key lessons learned from current implementation efforts.
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Affiliation(s)
- Emmeline Chuang
- School of Social Welfare, Mack Center on Public and Nonprofit Management in the Human Services, University of California, Berkeley, California, USA;
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University, Stanford, California, USA
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2
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Nistler CM, James TL, Dugan E, Pino EC. Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2286-2312. [PMID: 35604722 DOI: 10.1177/08862605221101395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury.Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.
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Affiliation(s)
- Conor M Nistler
- 27118Boston University School of Public Health, Boston, MA, USA
| | - Thea L James
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
| | - Elizabeth Dugan
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
| | - Elizabeth C Pino
- Department of Emergency Medicine, Boston Violence Intervention Advocacy Program (VIAP), 1836Boston Medical Center, Boston, MA, USA
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Snow KJ, Petrie D, Young JT, Preen DB, Heffernan E, Kinner SA. Impact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study. Aust J Prim Health 2022; 28:264-270. [PMID: 35512815 DOI: 10.1071/py21142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective. METHODS A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs. RESULTS Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6-4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6-5.0), compared with no past diagnosis of either mental illness or substance use disorder. CONCLUSIONS People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.
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Affiliation(s)
- K J Snow
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - D Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Vic., Australia
| | - J T Young
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic. 3053, Australia; and School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; and National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - D B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - E Heffernan
- Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Qld, Australia
| | - S A Kinner
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic. 3053, Australia; and Centre for Adolescent Health, Murdoch Children's Research Institute, Carlton, Vic., Australia; and Griffith Criminology Institute, Griffith University, Mount Gravatt, Qld, Australia; and Mater Research Institute-UQ, School of Medicine, University of Queensland, Brisbane, Qld, Australia; and School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Zellmer L, Johnson B, Idris A, Mehus CJ, Borowsky IW. Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study. J Gen Intern Med 2022; 37:802-808. [PMID: 34331212 PMCID: PMC8904656 DOI: 10.1007/s11606-021-07033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established. OBJECTIVE To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed. DESIGN We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together. PARTICIPANTS Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area. APPROACH Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis. KEY RESULTS Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports. CONCLUSIONS This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.
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Affiliation(s)
- Lucas Zellmer
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Bryan Johnson
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Ahmed Idris
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Christopher J Mehus
- Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, MN, USA
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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Pino EC, Fontin F, James TL, Dugan E. Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma. J Trauma Acute Care Surg 2022; 92:511-519. [PMID: 34284465 DOI: 10.1097/ta.0000000000003364] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound). METHODS This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury. RESULTS Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51-0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21-2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11-20.65). CONCLUSION Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence-gunshot victims and stabbing/assault victims-with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE Prognostic and Epidemiologic; level III.
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Affiliation(s)
- Elizabeth C Pino
- From the Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
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Lanford D, Petiwala A, Landers G, Minyard K. Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:432-447. [PMID: 34018268 PMCID: PMC9291477 DOI: 10.1111/hsc.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 06/01/2023]
Abstract
Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.
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Affiliation(s)
- Daniel Lanford
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Aliza Petiwala
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Glenn Landers
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Karen Minyard
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
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FLEMING MARKD, SHIM JANETK, YEN IRENE, DUBBIN LESLIE, THOMPSON‐LASTAD ARIANA, HANSSMANN CHRISTOPH, BURKE NANCYJ. Managing the "hot spots": Health care, policing, and the governance of poverty in the US. AMERICAN ETHNOLOGIST 2021; 48:474-488. [PMID: 35095125 DOI: 10.1111/amet.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health care systems in the United States are experimenting with a form of surveillance and intervention known as "hot spotting," which targets high-cost patients-the so-called "super-utilizers" of emergency departments-with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures on health care for impoverished people. Through an ethnographic investigation of hot spotting's modes of distribution and its workings in the lives of patients and providers, we find that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. This has led to a convergence of caring and punitive strategies of governance. The boundaries between them are shifting as a financialized logic of governance has come to dominate both health and criminal justice. [health care, chronic illness, governance, policing, poverty, United States].
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Affiliation(s)
- MARK D. FLEMING
- School of Public Health University of California 2121 Berkeley Way West Berkeley CA 94720–7360
| | - JANET K. SHIM
- Social and Behavioral Sciences University of California San Francisco
| | - IRENE YEN
- Public Health University of California Merced
| | - LESLIE DUBBIN
- Social and Behavioral Sciences University of California San Francisco
| | | | - CHRISTOPH HANSSMANN
- Women & Gender Studies San Francisco State University San Francisco California
| | - NANCY J. BURKE
- Anthropology and Public Health University of California Merced
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Pino EC, Fontin F, James TL, Dugan E. Boston Violence Intervention Advocacy Program: Challenges and Opportunities for Client Engagement and Goal Achievement. Acad Emerg Med 2021; 28:281-291. [PMID: 33111373 DOI: 10.1111/acem.14162] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES A better understanding of the factors affecting client engagement in hospital-based violence intervention programs (HVIPs), and which types of client needs prove most challenging to achieve, may be of key importance in developing novel, targeted strategies to violence intervention. In this study, we examined the demographics and injury characteristics of violently injured patients by their level of engagement with the Boston Violence Intervention Advocacy Program (VIAP) and determined the degree of client goal achievement through VIAP client services. METHODS This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury due to community violence between 2013 and 2018. Data on client demographics, injury characteristics, and client needs were collected from the VIAP data repository. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals to assess the difference in hazards of client goal achievement by need type. RESULTS Of the 2,243 victims of violent injury, 839 (37.4%) patients engaged with VIAP. Significant predictors of client engagement include younger age, Black race, permanent home, existing mental health diagnosis, gunshot wound, and more severe injuries. Conversely, older age, homelessness, substance use, stab wound, and less severe injuries predicted refusal of VIAP services. For clients who chose to engage with VIAP, needs related to education (HR = 0.47, 95% CI = 0.38 to 0.58), employment (HR = 0.66, 95% CI = 0.57 to 0.77), and housing (HR = 0.76, 95% CI = 0.68 to 0.86) were significantly less likely to be achieved compared to basic needs. CONCLUSIONS This study demonstrates that VIAP is effectively engaging the client population that HVIPs have been designed to support. HVIPs should consider novel strategies to engage vulnerable populations not typically targeted by intervention programs. These results speak to the difficulties of program attrition and the complexities of altering the life course for victims of violence.
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Affiliation(s)
- Elizabeth C. Pino
- From the Department of Emergency Medicine Boston Violence Intervention Advocacy Program (VIAP) Boston Medical Center Boston MA USA
| | - Francesca Fontin
- From the Department of Emergency Medicine Boston Violence Intervention Advocacy Program (VIAP) Boston Medical Center Boston MA USA
| | - Thea L. James
- From the Department of Emergency Medicine Boston Violence Intervention Advocacy Program (VIAP) Boston Medical Center Boston MA USA
| | - Elizabeth Dugan
- From the Department of Emergency Medicine Boston Violence Intervention Advocacy Program (VIAP) Boston Medical Center Boston MA USA
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Howell BA, Bart G, Wang EA, Winkelman TN. Service Involvement Across Multiple Sectors Among People Who Use Opioids, Methamphetamine, or Both, United States-2015-2018. Med Care 2021; 59:238-244. [PMID: 33165146 PMCID: PMC7878287 DOI: 10.1097/mlr.0000000000001460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The fourth wave of the opioid crisis is characterized by increased use and co-use of methamphetamine. How opioid and methamphetamine co-use is associated with health care use, housing instability, social service use, and criminal justice involvement has not been studied and could inform future interventions and partnerships. OBJECTIVES To estimate service involvement across sectors among people who reported past year opioid and methamphetamine co-use, methamphetamine use, opioid use, or neither opioid nor methamphetamine use. RESEARCH DESIGN We examined 2015-2018 data from the National Survey on Drug Use and Health. We used multivariable negative binomial and logistic regression models and predictive margins, adjusted for sociodemographic and clinical characteristics. SUBJECTS Nonelderly US adults aged 18 or older. MEASURES Hospital days, emergency department visits, housing instability, social service use, and criminal justice involvement in the past year. RESULTS In adjusted analyses, adults who reported opioid and methamphetamine co-use had 99% more overnight hospital days, 46% more emergency department visits, 2.1 times more housing instability, 1.4 times more social service use, and 3.3 times more criminal justice involvement compared with people with opioid use only. People who used any methamphetamine, with opioids or alone, were significantly more likely be involved with services in 2 or more sectors compared with those who used opioids only (opioids only: 11.6%; methamphetamine only: 19.8%; opioids and methamphetamine: 27.6%). CONCLUSIONS Multisector service involvement is highest among those who use both opioids and methamphetamine, suggesting that partnerships between health care, housing, social service, and criminal justice agencies are needed to develop, test, and implement interventions to reduce methamphetamine-related morbidity.
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Affiliation(s)
- Benjamin A. Howell
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
- Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Emily A. Wang
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT
- Division of General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Tyler N.A. Winkelman
- Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
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Eliacin J, Yang Z, Kean J, Dixon BE. Characterizing health care utilization following hospitalization for a traumatic brain injury: a retrospective cohort study. Brain Inj 2021; 35:119-129. [PMID: 33356602 DOI: 10.1080/02699052.2020.1861650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/31/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Objective: The purpose of this study was to characterize health services utilization among individuals hospitalized with a traumatic brain injury (TBI) 1-year post-injury.Methods: Using a retrospective cohort design, adult patients (n = 32, 042) hospitalized with a traumatic brain injury between 2005 and 2014 were selected from a statewide traumatic brain injury registry. Data on health services utilization for 1-year post-injury were extracted from electronic medical and administrative records. Descriptive statistics and logistic regression were used to characterize the cohort and a subgroup of superutilizers of health services.Results: One year after traumatic brain injury, 56% of participants used emergency department services, 80% received inpatient services, and 93% utilized outpatient health services. Superutilizers had ≥3 emergency department visits, ≥3 inpatient admissions, or ≥26 outpatient visits 1-year post-injury. Twenty-six percent of participants were superutilizers of emergency department services, 30% of inpatient services, and 26% of outpatient services. Superutilizers contributed to 81% of emergency department visits, 70% of inpatient visits, and 60% of outpatient visits. Factors associated with being a superutilizer included sex, race, residence, and insurance type.Conclusions: Several patient characteristics and demographic factors influenced patients' healthcare utilization post-TBI. Findings provide opportunities for developing targeted interventions to improve patients' health and traumatic brain injury-related healthcare delivery.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University - Indianapolis, Indianapolis, USA
- Health Services Research, Regenstrief Institute, Inc., Indianapolis, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University-Purdue University - Indianapolis, Indianapolis, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA
- Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, USA
| | - Brian E Dixon
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, USA
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Treglia D, Johns EL, Schretzman M, Berman J, Culhane DP, Lee DC, Doran KM. When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers. Health Aff (Millwood) 2020; 38:1458-1467. [PMID: 31479375 DOI: 10.1377/hlthaff.2018.05308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.
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Affiliation(s)
- Dan Treglia
- Dan Treglia is a postdoctoral fellow in the School of Social Policy and Practice, University of Pennsylvania, in Philadelphia
| | - Eileen L Johns
- Eileen L. Johns is director of policy and research at the New York City Center for Innovation through Data Intelligence
| | - Maryanne Schretzman
- Maryanne Schretzman is executive director of the New York City Center for Innovation through Data Intelligence
| | - Jacob Berman
- Jacob Berman is a research analyst at the New York City Center for Innovation through Data Intelligence
| | - Dennis P Culhane
- Dennis P. Culhane holds the Dana and Andrew Stone Chair in Social Policy at the University of Pennsylvania
| | - David C Lee
- David C. Lee is an assistant professor in the Departments of Emergency Medicine and Population Health, New York University School of Medicine, in New York City
| | - Kelly M Doran
- Kelly M. Doran ( ) is an assistant professor in the Departments of Emergency Medicine and Population Health, New York University School of Medicine
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Alderwick H, Hood-Ronick CM, Gottlieb LM. Medicaid Investments To Address Social Needs In Oregon And California. Health Aff (Millwood) 2020; 38:774-781. [PMID: 31059356 DOI: 10.1377/hlthaff.2018.05171] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Health care organizations across the US are developing new approaches to addressing patients' social needs. Medicaid programs are uniquely placed to support these activities, given their central role in supporting low-income Americans. Yet little evidence is available to guide Medicaid initiatives in this area. We used qualitative methods to examine how Medicaid funding was used to support social interventions in sites involved in payment reforms in Oregon and California. Investments were made in direct services-including care coordination, housing services, food insecurity programs, and legal supports-as well as capacity-building programs for health care and community-based organizations. A mix of Medicaid funding sources was used to support these initiatives, including alternative models and savings. We identified several factors that influenced program implementation, including the local health system context and wider community factors. Our findings offer insights to health care leaders and policy makers as they develop new approaches to improving population health.
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Affiliation(s)
- Hugh Alderwick
- Hugh Alderwick ( ) is assistant director of policy at the Health Foundation, in London, United Kingdom. He carried out the research for this article when he was a Harkness Fellow and visiting scholar in the Center for Health and Community, University of California San Francisco
| | - Carlyn M Hood-Ronick
- Carlyn M. Hood-Ronick is the senior manager, health equity, at the Oregon Primary Care Association, in Portland
| | - Laura M Gottlieb
- Laura M. Gottlieb is an associate professor in the Department of Family and Community Medicine, University of California San Francisco
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Garrett N, Bikah Bi Nguema Engoang JA, Rubin S, Vickery KD, Winkelman TNA. Health system resource use among populations with complex social and behavioral needs in an urban, safety-net health system. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2020; 8:100448. [PMID: 32919587 DOI: 10.1016/j.hjdsi.2020.100448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Costs incurred by health systems when caring for populations with social or behavioral complexity are poorly understood. We compared the frequency and costs of unreimbursed care among individuals with complexity factors (homelessness, a history of county jail incarceration, and/or substance use disorder or mental illness [SUD/MI]). METHODS We conducted a cross-sectional analysis using electronic health record data for adults aged 18 and older between January 1, 2016 and December 31, 2017 from a Midwestern safety-net health system. Zero-inflated negative binomial regression models were used to assess risk-adjusted associations between complexity factors and care coordination encounters, missed appointments, and excess inpatient days. RESULTS Our sample included 154,719 unique patients; 6.8% were identified as homeless, 7.8% had a history of county jail incarceration, and 20.6% had SUD/MI. Individuals with complexity factors were more likely to be African-American, Native American, or covered by Medicaid. In adjusted models, homelessness and SUD/MI were significantly associated with care coordination encounters (RR 1.8 [95% CI,1.7-2.0]; RR 1.9 [95% CI,1.8-2.0]), missed appointments (RR 1.5 [95% CI,1.4-1.6]; RR 1.7 [95% CI,1.7-1.8]), and excess inpatient days (RR 1.5 [95% CI,1.3-1.8]; RR 2.8 [95% CI,2.5-3.1]). County jail incarceration was associated with a significant increase in missed appointments. In 2017, SUD/MI accounted for 81.8% ($7,773,000/$9,502,000) of excess costs among those with social or behavioral complexity. CONCLUSIONS Social and behavioral complexity are independently associated with high levels of unreimbursed health system resource use. IMPLICATIONS Future payment models should account for the health system resources required to care for populations with complex social and behavioral needs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nancy Garrett
- Analytics Center of Excellence, Hennepin Healthcare, Minneapolis, MN, USA; Aetna, Hartford, CT, USA
| | | | - Stephen Rubin
- Analytics Center of Excellence, Hennepin Healthcare, Minneapolis, MN, USA
| | - Katherine Diaz Vickery
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Health, Homelessness, And Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Health, Homelessness, And Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
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Chuang E, Pourat N, Haley LA, O’Masta B, Albertson E, Lu C. Integrating Health And Human Services In California’s Whole Person Care Medicaid 1115 Waiver Demonstration. Health Aff (Millwood) 2020; 39:639-648. [DOI: 10.1377/hlthaff.2019.01617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Emmeline Chuang
- Emmeline Chuang is an associate professor in the University of California Berkeley School of Social Welfare; director of the UC Berkeley Mack Center on Nonprofit and Public Sector Management in the Human Services; and an adjunct associate professor in the University of California Los Angeles (UCLA) Fielding School of Public Health
| | - Nadereh Pourat
- Nadereh Pourat is a professor in the Department of Health Policy and Management, UCLA Fielding School of Public Health, and associate director of the UCLA Center for Health Policy Research
| | - Leigh Ann Haley
- Leigh Ann Haley is a project manager and research analyst at the UCLA Center for Health Policy Research
| | - Brenna O’Masta
- Brenna O’Masta is a project manager and research analyst at the UCLA Center for Health Policy Research
| | - Elaine Albertson
- Elaine Albertson is a PhD candidate in the UCLA Fielding School of Public Health
| | - Connie Lu
- Connie Lu is a project manager and research analyst at the UCLA Center for Health Policy Research
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Abstract
BACKGROUND Efforts to improve outcomes for the 10% of patients using two thirds of health care expenditures increasingly include addressing social determinants. Empiric evidence is needed to identify the highest impact nonmedical drivers of medical complexity and cost. OBJECTIVES This study examines whether complex, highest cost patients have different patterns of critical life adversity than those with better health and lower utilization. RESEARCH DESIGN Using a validated algorithm we constructed a complexity/cost risk patient profile. We developed and fielded a life experience survey (Supplemental Digital Content 1, http://links.lww.com/MLR/B920) to a representative sample, then examined how the prevalence of specific adversities varied between complex, high-cost individuals, and others. SUBJECTS Surveys were sent to 9176 adult Medicaid members in Portland, Oregon. MEASURES Our primary variable was high medical complexity health cost risk; an alternative specification combined health cost risk and actual utilization/cost. Our survey instrument measured exposure to early and later-life adversities. RESULTS Compared with healthy individuals in our population, medically complex individuals had significantly higher rates of adversity. The greatest risk of medical complexity and cost was associated with substance use [odds ratio (OR), 4.1], homelessness (OR, 3.0), childhood maltreatment (OR, 2.8), and incarceration (OR 2.4). Those with the highest prior year acute care utilization and cost had the highest rates of these same factors: substance use (62.5%), homelessness (61.7%), childhood maltreatment (55.5%), and incarceration (52.1%). CONCLUSION Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients.
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Affiliation(s)
| | - Bill Wright
- Center for Outcomes Research and Education, Portland, OR
| | | | - Megan Holtorf
- Center for Outcomes Research and Education, Portland, OR
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Kanzaria HK, Niedzwiecki M, Cawley CL, Chapman C, Sabbagh SH, Riggs E, Chen AH, Martinez MX, Raven MC. Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses The Whole Person. Health Aff (Millwood) 2019; 38:1866-1875. [DOI: 10.1377/hlthaff.2019.00082] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Hemal K. Kanzaria
- Hemal K. Kanzaria is an associate professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies, both at the University of California San Francisco (UCSF)
| | - Matthew Niedzwiecki
- Matthew Niedzwiecki is a health researcher at Mathematica Policy Research in Oakland, California
| | - Caroline L. Cawley
- Caroline L. Cawley is a research associate in the Department of Emergency Medicine, UCSF
| | - Carol Chapman
- Carol Chapman is a program analyst in the San Francisco Department of Public Health, in California
| | - Sarah H. Sabbagh
- Sarah H. Sabbagh is a health policy research associate in the Department of Emergency Medicine, UCSF
| | - Emily Riggs
- Emily Riggs is supervisor of business intelligence analytics, San Francisco Health Plan, in California
| | - Alice Hm Chen
- Alice Hm Chen is deputy director and chief medical officer, San Francisco Health Network, San Francisco Department of Public Health
| | - Maria X. Martinez
- Maria X. Martinez is director of Whole Person Care in the San Francisco Department of Public Health
| | - Maria C. Raven
- Maria C. Raven is an associate professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies, UCSF
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17
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Howell BA, Wang EA, Winkelman TNA. Mental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act. Psychiatr Serv 2019; 70:765-771. [PMID: 31138056 DOI: 10.1176/appi.ps.201800559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to assess changes in health insurance coverage and mental health treatment among individuals with and without involvement in the criminal justice system after implementation of key provisions of the Affordable Care Act (ACA). METHODS Data from the National Survey on Drug Use and Health were used to assess changes in coverage, mental health treatment, and payer between 2011-2013 and 2014-2017 for nonelderly adults (ages 19 to 64) with and without criminal justice involvement in the past year who reported serious psychological distress. Multivariable logistic regression was used to obtain adjusted estimates. RESULTS The weighted sample represented, on average, 2.0 million individuals with criminal justice involvement (total unweighted N=3,688) and 20.9 million without criminal justice involvement (total unweighted N=33,872) in each study year. Following implementation of the ACA's key provisions, health insurance coverage increased by 13.4 percentage points (95% CI=8.5-18.3) among individuals with past year criminal justice involvement and by 8.1 percentage points (95% CI=6.9-9.4) among those without. Receipt of any mental health treatment did not change significantly among individuals with criminal justice involvement (-3.4 percentage points [95% CI=-8.0 to 1.1]), whereas it increased significantly in the general population (2.2 percentage points [95% CI=0.4-3.9]). CONCLUSIONS Despite an increase in health insurance coverage for people with criminal justice involvement, there was no increase in mental health treatment following implementation of the ACA's key provisions. Health insurance coverage is necessary, but not sufficient, to expand access to mental health treatment for individuals involved in the criminal justice system.
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Affiliation(s)
- Benjamin A Howell
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Emily A Wang
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Tyler N A Winkelman
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
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18
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Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees. Med Care 2019; 57:123-130. [PMID: 30461582 DOI: 10.1097/mlr.0000000000001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. OBJECTIVE The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. RESEARCH DESIGN We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. MEASURES Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. RESULTS We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. CONCLUSIONS Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
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Beck AF, Cohen AJ, Colvin JD, Fichtenberg CM, Fleegler EW, Garg A, Gottlieb LM, Pantell MS, Sandel MT, Schickedanz A, Kahn RS. Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care. Pediatr Res 2018; 84:10-21. [PMID: 29795202 DOI: 10.1038/s41390-018-0012-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/05/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023]
Abstract
The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.
| | - Alicia J Cohen
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Jeffrey D Colvin
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Caroline M Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
| | - Eric W Fleegler
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Garg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew S Pantell
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Megan T Sandel
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam Schickedanz
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Robert S Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
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McConville S, Mooney AC, Williams BA, Hsia RY. How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California. BMJ Open 2018; 8:e020897. [PMID: 29929952 PMCID: PMC6042586 DOI: 10.1136/bmjopen-2017-020897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage. DESIGN Retrospective, cross-sectional study. SETTING Analyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014. PARTICIPANTS Study participants included 3 757 870 non-elderly adult ED patients who made at least one ED visit in 2014. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed the patterns and characteristics of ED visits among those with criminal justice contact-patients who were either admitted to or discharged from the ED by a correctional institution-with patients who did not have criminal justice contact recorded during an ED visit. RESULTS ED patients with criminal justice contact had higher proportions of frequent ED users (27.2% vs 9.4%), were at higher risk of an ED visit resulting in hospitalisation (26.6% vs 15.2%) and had higher prevalence of mental health conditions (52.8% vs 30.4%) compared with patients with no criminal justice contact recorded during an ED visit. Of the top 10, four primary diagnoses among patients with criminal justice contact were related to behavioural health conditions, accounting for 19.0% of all primary diagnoses in this population. In contrast, behavioural health conditions were absent from the top 10 primary diagnoses in ED patients with no observed criminal justice contact. Despite a high burden of disease, a lack of health insurance coverage was more common among those with criminal justice contact than those without (41.3% vs 14.1%). CONCLUSIONS Given that a large proportion of ED patients with criminal justice contact are frequent users with considerable mental health conditions, current efforts in California's Medicaid programme to identify individuals in need of coordinated services could reduce costly ED utilisation among this group.
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Affiliation(s)
| | - Alyssa C Mooney
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Brie A Williams
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Renee Y Hsia
- Department of Emergency Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
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Briggs ADM, Alderwick H, Fisher ES. Overcoming Challenges to US Payment Reform: Could a Place-Based Approach Help? JAMA 2018; 319:1545-1546. [PMID: 29601630 PMCID: PMC5944326 DOI: 10.1001/jama.2018.1542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adam D M Briggs
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Hugh Alderwick
- Center for Health and Community, University of California, San Francisco
| | - Elliott S Fisher
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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