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Tomovic M, Balfour ME, Cho T, Prathap N, Harootunian G, Mehreen R, Ostrovsky A, Goldman ML. Patient Flow and Reutilization of Crisis Services Within 30 Days in a Comprehensive Crisis System. Psychiatr Serv 2024:appips20230232. [PMID: 38410037 DOI: 10.1176/appi.ps.20230232] [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: 02/28/2024]
Abstract
OBJECTIVE Crisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services. METHODS This cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point. RESULTS Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. CONCLUSIONS Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.
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Affiliation(s)
- Milos Tomovic
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Margaret E Balfour
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Ted Cho
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Nishanth Prathap
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Gevork Harootunian
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Raihana Mehreen
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Andrey Ostrovsky
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Matthew L Goldman
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
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Goldman ML, McDaniel M, Manjanatha D, Rose ML, Santos GM, Shade SB, Lazar AA, Myers JJ, Handley MA, Coffin PO. Impact of San Francisco's New Street crisis response Team on Service use among people experiencing homelessness with mental and substance use disorders: A mixed methods study protocol. PLoS One 2023; 18:e0295178. [PMID: 38051726 PMCID: PMC10697604 DOI: 10.1371/journal.pone.0295178] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Mobile crisis services for people experiencing distress related to mental health or substance use are expanding rapidly across the US, yet there is little evidence to support these specific models of care. These new programs present a unique opportunity to expand the literature by utilizing implementation science methods to inform the future design of crisis systems. This mixed methods study will examine the effectiveness and acceptability of the Street Crisis Response Team (SCRT), a new 911-dispatched multidisciplinary mobile crisis intervention piloted in San Francisco, California. First, using quantitative data from electronic health records, we will conduct an interrupted time series analysis to quantitatively examine the impacts of the SCRT on people experiencing homelessness who utilized public behavioral health crisis services in San Francisco between November 2019 and August 2022, across four main outcomes within 30 days of the crisis episode: routine care utilization, crisis care reutilization, assessment for housing services, and jail entry. Second, to understand its impact on health equity, we will analyze racial and ethnic disparities in these outcomes prior to and after implementation of the SCRT. For the qualitative component, we will conduct semi-structured interviews with recipients of the SCRT's services to understand their experiences of the intervention and to identify how the SCRT influenced their health-related trajectories after the crisis encounter. Once complete, the quantitative and qualitative findings will be further analyzed in tandem to assist with more nuanced understanding of the effectiveness of the SCRT program. This evaluation of a novel mobile crisis response program will advance the field, while also providing a model for how real-world program implementation can be achieved in crisis service settings.
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Affiliation(s)
- Matthew L. Goldman
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Megan McDaniel
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Deepa Manjanatha
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States of America
| | - Monica L. Rose
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States of America
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Oral Epidemiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Janet J. Myers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Phillip O. Coffin
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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Odes R, Manjanatha D, Looper P, McDaniel M, Goldman ML. How to Reach a Mobile Crisis Team: Results From a National Survey. Psychiatr Serv 2023; 74:1084-1085. [PMID: 36935621 PMCID: PMC10999132 DOI: 10.1176/appi.ps.20220449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Rachel Odes
- National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Deepa Manjanatha
- National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Preston Looper
- National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Megan McDaniel
- National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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Purtle J, Goldman ML, Stuart EA. Interpreting Between-State Variation in 988 Suicide and Crisis Lifeline Call Volume Rates. Psychiatr Serv 2023; 74:901. [PMID: 37654119 PMCID: PMC10726139 DOI: 10.1176/appi.ps.23074015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health
| | - Matthew L. Goldman
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Elizabeth A. Stuart
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
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Abstract
OBJECTIVE The authors investigated associations between rates of contact with individuals in distress during field visits by mobile crisis teams and client and referral source characteristics. METHODS In this retrospective observational study of an urban mobile crisis program, call logs (N=2,581) were coded for whether an attempted field visit resulted in a client evaluation. Logistic regression analyses examined potential associations with client age, gender, race-ethnicity, primary language, living situation, insurance, and referral source. RESULTS Contact was made with 77% of adults and 97% of children referred to mobile crisis teams. Field visit contact rates differed by age. Unsuccessful visits were more likely when the referral source was from institutional settings than from individuals. CONCLUSIONS Approximately one-quarter of attempted field visits with adults by an urban mobile crisis team were not completed, particularly among referrals from institutional settings. As mobile crisis services proliferate, field visit contact rate could be a key performance metric for these critical services.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Andrea N Ponce
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Marilyn Thomas
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephanie Felder
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephen Wu
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Rachel Loewy
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Christina Mangurian
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
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Purtle J, Chance Ortego J, Bandara S, Goldstein A, Pantalone J, Goldman ML. Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing. J Ment Health Policy Econ 2023; 26:85-95. [PMID: 37357873 PMCID: PMC10758993] [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] [Grants] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/06/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Per federal law, "988" became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing "1-800-283-TALK"). AIMS OF THE STUDY This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand. METHOD A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call (USD 82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state's population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand. RESULTS 988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change = +32.8%, SD = +20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately USD 46 million. The within-state mean estimate of additional cost per state resident was +USD 0.16 (SD = +USD 0.11). The additional annual cost per state resident exceeded USD 0.40 in three states, was between USD 0.40- USD 0.30 in three states, and between USD 0.30 - USD 0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = USD 1.51, SD = USD 1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = USD 0.36, SD = USD 0.39). State funding increases exceeded the estimated cost increases in about half of states. CONCLUSIONS The Lifeline's transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.
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Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA,
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Erickson BR, Ehrie J, Goldman ML. A Call for Synergy in Psychiatric and Structural Policy, Research, and Intervention. Psychiatr Serv 2023; 74:669-670. [PMID: 37259590 PMCID: PMC10919937 DOI: 10.1176/appi.ps.20230150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, and San Francisco Department of Public Health, San Francisco (Goldman)
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Abstract
Federal and institutional policy changes have accelerated the use of telemental health to care for college students distant from their mental health providers during the early part of the COVID-19 pandemic. Temporary measures have made telemental health more readily available, including relaxing of regulations related to interstate licensure, controlled substance prescribing, patient privacy, and reimbursement. Though early efforts are underway to sustain these changes during and in the wake of the pandemic, there are important areas in which federal and institutional policy are still lacking. Additional steps are needed to successfully implement and sustain telemental health for college students include ensuring student access to technology and Internet; proactive outreach to optimize the student's home environment, addressing concerns about safety and confidentiality; developing the means to track rapidly shifting telemental health policy changes; and developing centralized resources that enable remote providers to become familiar with involuntary commitment laws and emergency protocols.
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Affiliation(s)
- Yash S Huilgol
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, California, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
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Erickson BR, Ehrie J, Murray S, Dougherty RJ, Wainberg ML, Dixon LB, Goldman ML. A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond. Psychiatr Serv 2023; 74:282-291. [PMID: 36039554 PMCID: PMC9971341 DOI: 10.1176/appi.ps.20220196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. METHODS The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. RESULTS For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. CONCLUSIONS An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Samuel Murray
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Ryan J Dougherty
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Milton L Wainberg
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
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Smith TE, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Wang R, Rodgers I, Dixon LB, Olfson M, Lewis-Fernández R. Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization. Psychiatr Serv 2023:appips20220110. [PMID: 36651116 DOI: 10.1176/appi.ps.20220110] [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: 01/19/2023]
Abstract
OBJECTIVE This study used an ecosocial perspective to examine ethnoracial disparities in timely outpatient follow-up care after psychiatric hospitalization in a cohort of Medicaid recipients. METHODS This retrospective analysis used 2012-2013 New York State Medicaid claims data for 17,488 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. Claims data were linked to other administrative data sets capturing key social conditions and determinants of mental health for non-Latinx White (White hereafter), non-Latinx Black (Black), Latinx, non-Latinx Asian/Pacific Islander (Asian/Pacific Islander), non-Latinx American Indian or Native Alaskan (American Indian or Native Alaskan), and other ethnoracial groups. Regression models were used to estimate the variations in disparities in timely follow-up care that were attributable to community, organization (i.e., hospital), and individual patient characteristics. RESULTS Overall, 60.1% of patients attended an outpatient mental health visit within 30 days of discharge. Compared with the rate for White patients, the attendance rates were 9.5 percentage points lower for Black patients and 7.8 percentage points higher for Asian/Pacific Islander patients. No significant difference in attendance rates was found between Latinx and White patients. Community factors, specifically urban versus rural classification and county poverty status, accounted for the greatest variation in timely follow-up care in all comparisons. CONCLUSIONS Efforts to increase connection to outpatient mental health follow-up care after psychiatric hospitalization should incorporate cultural and structural competencies to address social conditions and determinants of mental health that underly ethnoracial disparities.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Tom Corbeil
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Fei Tang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Susan M Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Eric Frimpong
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Franco Mascayano
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Marleen Radigan
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Rui Wang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ian Rodgers
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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Goldman ML, Swartz MS, Norquist GS, Horvitz-Lennon M, Balasuriya L, Jorgensen S, Greiner M, Brinkley A, Hayes H, Isom J, Dixon LB, Druss BG. Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type. Psychiatr Serv 2022; 73:1165-1168. [PMID: 35378994 DOI: 10.1176/appi.ps.202100428] [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
Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marvin S Swartz
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Grayson S Norquist
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marcela Horvitz-Lennon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lilanthi Balasuriya
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Shea Jorgensen
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Miranda Greiner
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Amy Brinkley
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Heath Hayes
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Jessica Isom
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lisa B Dixon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Benjamin G Druss
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
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12
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Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatr Serv 2022; 73:658-669. [PMID: 34666512 DOI: 10.1176/appi.ps.202000721] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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
How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.
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Affiliation(s)
- Margaret E Balfour
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Arlene Hahn Stephenson
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ayesha Delany-Brumsey
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Jason Winsky
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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13
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Affiliation(s)
- Matthew L. Goldman
- San Francisco Department of Public Health, and Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCAUSA
| | - Sarah Y. Vinson
- Department of Psychiatry and Behavioral SciencesMorehouse School of Medicine, and Lorio ForensicsAtlantaGAUSA
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Smali E, Talley RM, Goldman ML, Pincus HA, Woodlock D, Chung H. A Continuum-Based Framework as a Practice Assessment Tool for Integration of General Health in Behavioral Health Care. Psychiatr Serv 2022; 73:636-641. [PMID: 34555921 DOI: 10.1176/appi.ps.202000708] [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: 12/01/2022]
Abstract
OBJECTIVE General medical conditions among patients with mental and substance use disorders are often not adequately detected and managed in behavioral health settings. The project described in this study sought to investigate how behavioral health clinics used a new general health integration (GHI) framework to assess integration efforts. METHODS Eleven community behavioral health clinics were introduced to a new continuum-based framework for use in GHI assessment. A multidisciplinary team in each clinic was tasked with identifying current GHI interventions according to several framework stages (preliminary, intermediate 1, intermediate 2, and advanced) among eight domains and 15 related subdomains. The clinics provided feedback on the framework's utility for GHI planning and advancement. RESULTS The clinics could readily identify distinct integration interventions within each domain and subdomain. Clinics reported strengths in the domains of trauma-informed care, self-management support, social service linkages, and quality improvement. Opportunities for future advancement in integration of general health services were identified in the major domains of screening and referral, evidence-based treatments, care teams, and sustainability. The clinics also described potential benefits of the framework to further advance and implement GHI best practices. CONCLUSIONS The clinics could use the framework as a practice assessment of integration efforts with minimal guidance and identify several evidence-based integration interventions. Some GHI interventions were seen as strengths and as opportunities for further advancement. Longitudinal evaluation among a larger number of and more geographically diverse behavioral health clinics seeking to advance their GHI practices will improve the GHI framework's generalizability and potential for dissemination.
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Affiliation(s)
- Ekaterina Smali
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Rachel M Talley
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Matthew L Goldman
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Harold Alan Pincus
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - David Woodlock
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Henry Chung
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
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Goldman ML, Scharf DM, Brown JD, Scholle SH, Pincus HA. Structural Components of Integrated Behavioral Health Care: A Comparison of National Programs. Psychiatr Serv 2022; 73:584-587. [PMID: 34496629 PMCID: PMC10961247 DOI: 10.1176/appi.ps.201900623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Initiatives that support and incentivize the integration of behavioral health and general medical care have become a focus of government strategies to achieve the triple aim of improved health, better patient experience, and reduced costs. The authors describe the components of four large-scale national initiatives aimed at integrating care for a wide range of behavioral health needs. Commonalities across these national initiatives highlight health care and social services needs that must be addressed to improve care for people with co-occurring behavioral health and general medical conditions. These findings can inform how to design, test, select, and align the most promising strategies for integrated care in a variety of settings.
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Affiliation(s)
- Matthew L. Goldman
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- San Francisco Department of Public Health, San Francisco, California
| | - Deborah M. Scharf
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | | | | | - Harold Alan Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, NY
- New York State Psychiatric Institute, New York, NY
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Rodgers I, Dixon LB, Olfson M. The Effectiveness of Discharge Planning for Psychiatric Inpatients With Varying Levels of Preadmission Engagement in Care. Psychiatr Serv 2022; 73:149-157. [PMID: 34157859 PMCID: PMC8695636 DOI: 10.1176/appi.ps.202000863] [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: 02/03/2023]
Abstract
OBJECTIVE This study examined the extent to which prehospital treatment engagement is related to posthospital follow-up treatment among psychiatric inpatients and whether the effects of inpatient discharge planning on posthospital follow-up treatment vary by level of pretreatment engagement in care. METHODS New York State Medicaid and other administrative databases were used to examine service use by 18,793 adult patients discharged to the community after inpatient psychiatric care in 2012-2013. Outcomes included attending an outpatient mental health service within 7 days and within 30 days after discharge. The sample was stratified by whether patients had high, partial, low, or no engagement in outpatient psychiatric services in the 6 months before admission. RESULTS Scheduling an outpatient appointment as part of the patient's discharge plan was significantly associated with attending outpatient psychiatric appointments, regardless of the patient's level of engagement in care before admission. The differences were most pronounced for patients who had not received any outpatient care in the 6 months before admission. When an appointment was scheduled, these patients were three times more likely to follow up with care within 7 days and more than twice as likely to follow up within 30 days than were patients without a scheduled appointment. CONCLUSIONS The likelihood of psychiatric inpatients following up with outpatient psychiatric care was directly related to their level of outpatient care engagement before hospital admission. Even among those who had not been engaged in outpatient care, inpatient discharge planning was associated with a greater likelihood of receiving follow-up outpatient care.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Ian Rodgers
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
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Goldman ML, Smali E, Richkin T, Pincus HA, Chung H. Implementation of Behavioral Health Integration in Small Primary Care Settings: Lessons Learned and Future Directions. Community Ment Health J 2022; 58:136-144. [PMID: 33638059 DOI: 10.1007/s10597-021-00802-z] [Citation(s) in RCA: 2] [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] [Received: 08/21/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
Primary care practices are in great need of practical guidance on the steps they can take to build behavioral health integration (BHI) capacities, particularly for smaller practice settings with fewer resources. 11 small primary care sites (≤ 5 providers) throughout New York State utilized a continuum framework of core components of BHI in combination with technical assistance. Surveys were collected at baseline, 6-months, and 12-months. Semi-structured interviews and focus groups were conducted during site visits, and a stakeholder roundtable was facilitated to address broader themes. Data were analyzed using qualitative thematic analysis. Practices reported successful engagement with the framework and actively participated in planning and advancing BHI operations. Greater success was observed in practices with existing on-site BHI services, identified champions for BHI, early and sustained training and involvement of providers and administrators, use of collaborative agreements with external behavioral health providers, and capacity to successfully receive reimbursements for BHI services. Advancing health information technologies was a challenge across sites. Financing and policy factors were viewed as critically important to advance integration efforts. The pilot of a continuum framework offers lessons for primary care practices and policymakers to advance integrated BH care.
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA. .,Comprehensive Crisis Services, San Francisco Department of Public Health, 1380 Howard St, San Francisco, CA, 94103, USA.
| | | | - Talia Richkin
- Research Foundation for Mental Health, Inc., New York, USA
| | - Harold Alan Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, USA
| | - Henry Chung
- Montefiore Health System and Albert Einstein College of Medicine, New York, USA
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Goldman ML, Smali E, Richkin T, Pincus HA, Chung H. A novel continuum-based framework for translating behavioral health integration to primary care settings. Transl Behav Med 2021; 10:580-589. [PMID: 32766870 DOI: 10.1093/tbm/ibz142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised "Framework 2.0" that includes a new organization as well as the addition of a "Sustainability" domain.
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Affiliation(s)
| | | | - Talia Richkin
- Research Foundation for Mental Health, Inc., New York, NY, USA
| | - Harold A Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Henry Chung
- Department of Psychiatry, Albert Einstein College of Medicines and Montefiore Health System, New York, NY, USA
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19
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care. Psychiatr Serv 2021; 72:498-506. [PMID: 33657838 PMCID: PMC8102313 DOI: 10.1176/appi.ps.202000021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined associations of patient, hospital, and service system factors with provision of discharge planning to individuals treated in hospital psychiatric units. METHODS This retrospective cohort analysis used 2012-2013 New York State Medicaid claims data of 18,185 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. The claims data were linked to data from managed behavioral health care organizations indicating whether inpatient staff scheduled a follow-up outpatient appointment with a mental health provider. Additional data regarding hospital and service system characteristics were obtained from the American Hospital Association Annual Survey, the Area Health Resource File, and other state administrative databases. Rates and adjusted odds ratios were assessed for the likelihood of inpatient staff scheduling a follow-up appointment. RESULTS Inpatient staff scheduled outpatient appointments for 79.8% of discharges. The adjusted odds of not having an outpatient appointment scheduled as part of the patient's discharge plan were significantly associated with several factors, including being homeless on admission, having a diagnosis of a co-occurring substance use disorder, having high levels of medical comorbid conditions, and not being engaged in psychiatric outpatient services in the month prior to admission. CONCLUSIONS Patient characteristics were more strongly associated with failure to receive discharge planning than were hospital and service system characteristics.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Abstract
National, state, and local actors seem ready to address the long-neglected mental health crisis system in the United States. Elements of an organized system of crisis care are in place in some states, including regional or statewide call centers, mobile crisis teams, and crisis care facilities. These necessary advances are not sufficient to address the urgent problems of increasing suicide rates, the inappropriate use of emergency departments to hold people in psychiatric distress, and the problematic reliance on inadequately trained law enforcement who frequently respond to mental health crises. This article describes the immediate challenges and opportunities that can launch nationwide reform in systems of care for individuals in psychiatric crisis. Five action recommendations describe clear, feasible next steps that can be taken to move these systems forward and meaningfully improve access and quality of care for people in crisis. The recommendations include a central coordinating role for Congress, an increase in federal authorization and appropriation of funds, enactment of a 5% Mental Health Block Grant set-aside, expanded funding for research and evaluation, and the pursuit of additional payment mechanisms by states and counties.
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Affiliation(s)
- Michael F Hogan
- Department of Psychiatry, Case Western Reserve University, Cleveland (Hogan); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Department of Psychiatry, Case Western Reserve University, Cleveland (Hogan); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
| | - Lilanthi Balasuriya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
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Li L, Kulp W, Goldman ML, Sernyak M, Petrakis I, Runnels P. COVID vaccine use in inpatient psychiatry units-The need is here and now. Gen Hosp Psychiatry 2021; 71:132-133. [PMID: 33814221 PMCID: PMC8006511 DOI: 10.1016/j.genhosppsych.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Luming Li
- Department of Psychiatry, Yale University, New Haven, CT, United States.
| | - William Kulp
- Department of Psychiatry, Yale University, New Haven, CT, United States.
| | | | - Michael Sernyak
- Department of Psychiatry, Yale University, New Haven, CT, United States.
| | - Ismene Petrakis
- Department of Psychiatry, Yale University, New Haven, CT, United States.
| | - Patrick Runnels
- Dept of Psychiatry, Case Western Reserve University School of Medicine, Euclid Ave., Cleveland, OH, United States.
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Goldman ML, Dixon LB. Suicide Prevention, Part 2: Evidence-Based Practices, Cost-Effectiveness, and Future Directions. Psychiatr Serv 2020; 71:1320-1321. [PMID: 33256525 DOI: 10.1176/appi.ps.711205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldman ML, Dixon LB. Suicide Prevention, Part 1: Identifying and Predicting Risk, Vulnerable Populations, Public Perceptions, and Priority Settings. Psychiatr Serv 2020; 71:1209-1210. [PMID: 33135600 DOI: 10.1176/appi.ps.711105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldman ML, Druss BG, Horvitz-Lennon M, Norquist GS, Kroeger Ptakowski K, Brinkley A, Greiner M, Hayes H, Hepburn B, Jorgensen S, Swartz MS, Dixon LB. Mental Health Policy in the Era of COVID-19. Psychiatr Serv 2020; 71:1158-1162. [PMID: 32517639 DOI: 10.1176/appi.ps.202000219] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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
The response to the global COVID-19 pandemic has important ramifications for mental health systems and the patients they serve. This article describes significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. These extraordinary advances provide an unprecedented opportunity to evaluate the effects of mental health policies that may be adopted in the post-COVID-19 era in the United States.
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Benjamin G Druss
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Marcela Horvitz-Lennon
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Grayson S Norquist
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Kristin Kroeger Ptakowski
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Amy Brinkley
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Miranda Greiner
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Heath Hayes
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Brian Hepburn
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Shea Jorgensen
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Marvin S Swartz
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Lisa B Dixon
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
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Runnels P, Coran JJ, Goldman ML, Pronovost P. Utilizing a Dashboard to Promote System-Wide Value in Behavioral Health. Popul Health Manag 2020; 24:427-429. [PMID: 33090070 DOI: 10.1089/pop.2020.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick Runnels
- Office of Clinical Transformation, University Hospitals Health Systems, Cleveland, Ohio, USA.,Departments of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Justin J Coran
- Office of Clinical Transformation, University Hospitals Health Systems, Cleveland, Ohio, USA
| | - Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Peter Pronovost
- Office of Clinical Transformation, University Hospitals Health Systems, Cleveland, Ohio, USA.,Anesthesiology and Critical Care, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Case Western Reserve University, Weatherhead School of Business Management and Cleveland, Ohio, USA.,Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Effect of Scheduling a Post-Discharge Outpatient Mental Health Appointment on the Likelihood of Successful Transition From Hospital to Community-Based Care. J Clin Psychiatry 2020; 81:20m13344. [PMID: 32936543 PMCID: PMC10476606 DOI: 10.4088/jcp.20m13344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. METHODS 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. RESULTS Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. CONCLUSIONS Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032.
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Morgan Haselden
- New York State Psychiatric Institute, New York, New York, USA
| | - Tom Corbeil
- New York State Psychiatric Institute, New York, New York, USA
| | - Melanie M Wall
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Susan M Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Matthew L Goldman
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York, USA
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mark Olfson
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Goldman ML, Patti TL, Levonian D, Yelin SF, Lukin MD. Optical Control of a Single Nuclear Spin in the Solid State. Phys Rev Lett 2020; 124:153203. [PMID: 32357057 DOI: 10.1103/physrevlett.124.153203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/15/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
We demonstrate a novel method for coherent optical manipulation of individual nuclear spins in the solid state, mediated by the electronic states of a proximal quantum emitter. Specifically, using the nitrogen-vacancy (NV) color center in diamond, we demonstrate control of a proximal ^{14}N nuclear spin via an all-optical Raman technique. We evaluate the extent to which the intrinsic physical properties of the NV center limit the performance of coherent control, and we find that it is ultimately constrained by the relative rates of transverse hyperfine coupling and radiative decay in the NV center's excited state. Possible extensions and applications to other color centers are discussed.
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Affiliation(s)
- M L Goldman
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - T L Patti
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - D Levonian
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S F Yelin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
- Department of Physics, University of Connecticut, Storrs, Connecticut 06269, USA
| | - M D Lukin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
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Goldman ML, Mangurian C, Corbeil T, Wall MM, Tang F, Haselden M, Essock SM, Frimpong E, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M, Smith TE. Medical comorbid diagnoses among adult psychiatric inpatients. Gen Hosp Psychiatry 2020; 66:16-23. [PMID: 32593912 PMCID: PMC8684817 DOI: 10.1016/j.genhosppsych.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 12/23/2019] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
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Affiliation(s)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital
| | | | - Melanie M. Wall
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Morgan Haselden
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Lisa B. Dixon
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Mark Olfson
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. Smith
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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Cunningham C, Dixon LB, Sawhney R, Robitz R, Richards M, Rodríguez Penney AT, Jordan A, Colon-Rivera H, Goldman ML, Zingman MA, Rolin SA. 2019 Editor's Choice Collections. Psychiatr Serv 2020; 71:105-107. [PMID: 31892287 DOI: 10.1176/appi.ps.71103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carrie Cunningham
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Lisa B. Dixon
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Rishi Sawhney
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Rachel Robitz
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Misty Richards
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Alan Tomás Rodríguez Penney
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Ayana Jordan
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Héctor Colon-Rivera
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Matthew L. Goldman
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Michael A. Zingman
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
| | - Stephanie A. Rolin
- Early Career Psychiatrist Advisory Committee: Hector Colon-Rivera, M.D., M.R.O., Carrie Cunningham, M.D., M.P.H., Ayana Jordan, M.D., Ph.D., Misty C. Richards, M.D., M.S., Rachel Robitz, M.D., Alan Tomás Rodríguez Penney, M.D., Stephanie A. Rolin, M.D., Rishi Sawhney, M.D. Collections Editors: Carrie Cunningham, M.D., M.P.H., and Matthew L. Goldman, M.D., M.S
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Talley RM, Rolin SA, Trejo BN, Goldman ML, Alves-Bradford JME, Dixon LB. Perspectives of Individuals With Serious Mental Illness on a Reverse-Colocated Care Model: A Qualitative Study. Psychiatr Serv 2019; 70:793-800. [PMID: 31109264 PMCID: PMC6718316 DOI: 10.1176/appi.ps.201800480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with serious mental illness experience excess mortality related to general medical comorbidities. Reverse-integrated and reverse-colocated models of care have been proposed as a system-level solution. Such models integrate primary care services within behavioral health settings. Further understanding of consumer perspectives on these models is needed to ensure that models adequately engage consumers on the basis of their expressed needs. This qualitative study examined the perspectives of English- and Spanish-speaking individuals with serious mental illness on their current experience with the management of their medical care and on a hypothetical reverse-colocated care model. METHODS Semistructured interviews were conducted in a purposive sample of 30 individuals with serious mental illness recruited from two outpatient mental health clinics affiliated with a comprehensive community-based program. The interview assessed the participant's current experience with the management of their health care, followed by a vignette describing a reverse--colocated care model and questions to elicit the participant's reaction to the vignette. An inductive thematic analysis was employed. RESULTS Consumers expressed positive views of the potential for working with trusted staff, increased communication, and access to care through reverse colocation. Reflections on current health management experience were notable for an emphasis on self-efficacy and receipt of support for self-management strategies from mental health clinicians. CONCLUSIONS Study findings add to prior literature indicating support for assistance with management of general medical health in the mental health setting among individuals with serious mental illness. Key themes similar to those in previous studies generate hypotheses for further evaluation.
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Affiliation(s)
- Rachel M Talley
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Barbara N Trejo
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Jean-Marie E Alves-Bradford
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Talley, Rolin, Goldman, Alves-Bradford, Dixon); New York State Psychiatric Institute, New York (Talley, Rolin, Alves-Bradford, Dixon); Vagelos College of Physicians and Surgeons, Columbia University, New York (Trejo). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | | | - Richard F Summers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Goldman ML, Bernstein CA, Konopasek L, Arbuckle M, Mayer LES. An Intervention Framework for Institutions to Meet New ACGME Common Program Requirements for Physician Well-Being. Acad Psychiatry 2018; 42:542-547. [PMID: 29470799 PMCID: PMC6070414 DOI: 10.1007/s40596-018-0882-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 06/08/2023]
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Pincus HA, Li M, Scharf DM, Spaeth-Rublee B, Goldman ML, Ramanuj PP, Ferenchick EK. Prioritizing quality measure concepts at the interface of behavioral and physical healthcare. Int J Qual Health Care 2018. [PMID: 28651345 DOI: 10.1093/intqhc/mzx071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/31/2022] Open
Abstract
Objective Integrated healthcare models can increase access to care, improve healthcare quality, and reduce cost for individuals with behavioral and general medical healthcare needs, yet there are few instruments for measuring the quality of integrated care. In this study, we identified and prioritized concepts that can represent the quality of integrated behavioral health and general medical care. Design We conducted a literature review to identify candidate measure concepts. Experts then participated in a modified Delphi process to prioritize the concepts for development into specific quality measures. Setting United States. Participants Expert behavioral health and general medical clinicians, decision-makers (policy, regulatory and administrative professionals) and patient advocates. Main outcome measures Panelists rated measure concepts on importance, validity and feasibility. Results The literature review identified 734 measures of behavioral or general medical care, which were then distilled into 43 measure concepts. Thirty-three measure concepts (including a segmentation strategy) reached a predetermined consensus threshold of importance, while 11 concepts did not. Two measure concepts were 'ready for further development' ('General medical screening and follow-up in behavioral health settings' and 'Mental health screening at general medical healthcare settings'). Among the 31 additional measure concepts that were rated as important, 7 were rated as valid (but not feasible), while the remaining 24 concepts were rated as neither valid nor feasible. Conclusions This study identified quality measure concepts that capture important aspects of integrated care. Researchers can use the prioritization process described in this study to guide healthcare quality measures development work.
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Affiliation(s)
- Harold Alan Pincus
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA.,New York-Presbyterian Hospital, 630 West 168th Street, New York, NY 10032, USA
| | - Mingjie Li
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA
| | - Deborah M Scharf
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay Ontario, P7B 5E1, Canada
| | - Brigitta Spaeth-Rublee
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA
| | - Matthew L Goldman
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 9, New York, NY 10032, USA.,Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Box 99, New York, NY 10032, USA
| | - Parashar P Ramanuj
- Royal National Orthopaedic Hospital, 45 Bolsover Street, London, W1W 5AQ, UK
| | - Erin K Ferenchick
- Center for Family and Community Medicine, Columbia University Medical Center, 610 West 158th Street, New York, NY 10032, USA
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Abstract
Extensive evidence documents that people with severe mental illness have higher rates of morbidity and mortality compared with the general population and receive lower-quality and higher-cost health care. These trends, at least in part, stem from discrimination, exclusion, widespread stigma, and criminalization of individuals with mental illness. As such, severe mental illness should receive formal, national recognition as a disparities category. Such a designation would have multiple important implications in health policy, services and quality research, and advocacy.
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Affiliation(s)
- Matthew L Goldman
- Dr. Goldman and Dr. Pincus are with the Department of Psychiatry, Columbia University, New York City, and Ms. Spaeth-Rublee is with the New York State Psychiatric Institute, New York City. Dr. Pincus is also with NewYork-Presbyterian Hospital, New York City
| | - Brigitta Spaeth-Rublee
- Dr. Goldman and Dr. Pincus are with the Department of Psychiatry, Columbia University, New York City, and Ms. Spaeth-Rublee is with the New York State Psychiatric Institute, New York City. Dr. Pincus is also with NewYork-Presbyterian Hospital, New York City
| | - Harold Alan Pincus
- Dr. Goldman and Dr. Pincus are with the Department of Psychiatry, Columbia University, New York City, and Ms. Spaeth-Rublee is with the New York State Psychiatric Institute, New York City. Dr. Pincus is also with NewYork-Presbyterian Hospital, New York City
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Affiliation(s)
| | - Mimi Levine
- PGY-3 Resident, Columbia Psychiatry Residency Program, New York State Psychiatric Institute/Columbia University Medical Center
| | - Matthew L Goldman
- Resident in Psychiatry, New York State Psychiatric Institute/Columbia University Medical Center
| | - Lalita Abhyankar
- Chief Resident in Family Medicine, Center for Family and Community Medicine, New York-Presbyterian Hospital/Columbia University Medical Center
| | - Lyuba Konopasek
- Designated Institutional Official, Graduate Medical Education, New York-Presbyterian Hospital
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Abstract
The development of quality measures has gained increasing attention as health care reimbursements transition from fee-for-service to value-based payment models. As behavioral health care moves towards integration of services with primary care, specific measures and payment incentives will be needed to successfully expand access. This study uses a keyword search to identify 730 quality indicators that are relevant to behavioral health and general medical health. Measures identified have been coded and grouped into domains based on a taxonomy developed by the authors. The analysis reveals that quality measures focusing on general medical conditions exceed those focused on behavioral health diagnoses for evidence-based treatments, patient safety, and outcomes. Furthermore, measures predominantly concentrate on care during or following hospitalizations, which represents a minority of behavioral health care and does not characterize the outpatient settings that are the focus of many models of integrated care. The authors offer recommendations for future steps to identify the quality measures that can best evaluate the evolving behavioral health care system.
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Affiliation(s)
- Matthew L Goldman
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Brigitta Spaeth-Rublee
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Abraham D Nowels
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | | | - Harold Alan Pincus
- New York State Psychiatric Institute, New York, NY, USA.
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA.
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- NewYork-Presbyterian Hospital, New York, USA.
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3New York-Presbyterian Hospital, New York
| | - Brigitta Spaeth-Rublee
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Harold Alan Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3New York-Presbyterian Hospital, New York
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Ravi N Shah
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
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Goldman ML, Ghorob A, Hessler D, Yamamoto R, Thom DH, Bodenheimer T. Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching? Ann Fam Med 2015; 13 Suppl 1:S36-41. [PMID: 26304970 PMCID: PMC4648140 DOI: 10.1370/afm.1756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/09/2022] Open
Abstract
PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling. METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTS Of the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches' perceptions of the training. CONCLUSIONS Of low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught.
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Affiliation(s)
- Matthew L Goldman
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Amireh Ghorob
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Danielle Hessler
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Russell Yamamoto
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - David H Thom
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Thomas Bodenheimer
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Ravi N Shah
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Carol A Bernstein
- Department of Psychiatry, New York University School of Medicine, New York
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Goldman ML, Sipahigil A, Doherty MW, Yao NY, Bennett SD, Markham M, Twitchen DJ, Manson NB, Kubanek A, Lukin MD. Phonon-induced population dynamics and intersystem crossing in nitrogen-vacancy centers. Phys Rev Lett 2015; 114:145502. [PMID: 25910136 DOI: 10.1103/physrevlett.114.145502] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Indexed: 06/04/2023]
Abstract
We report direct measurement of population dynamics in the excited state manifold of a nitrogen-vacancy (NV) center in diamond. We quantify the phonon-induced mixing rate and demonstrate that it can be completely suppressed at low temperatures. Further, we measure the intersystem crossing (ISC) rate for different excited states and develop a theoretical model that unifies the phonon-induced mixing and ISC mechanisms. We find that our model is in excellent agreement with experiment and that it can be used to predict unknown elements of the NV center's electronic structure. We discuss the model's implications for enhancing the NV center's performance as a room-temperature sensor.
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Affiliation(s)
- M L Goldman
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - A Sipahigil
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - M W Doherty
- Laser Physics Centre, Research School of Physics and Engineering, Australian National University, Australian Capital Territory 0200, Australia
| | - N Y Yao
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S D Bennett
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - M Markham
- Element Six Ltd, Kings Ride Park, Ascot SL5 8BP, United Kingdom
| | - D J Twitchen
- Element Six Ltd, Kings Ride Park, Ascot SL5 8BP, United Kingdom
| | - N B Manson
- Laser Physics Centre, Research School of Physics and Engineering, Australian National University, Australian Capital Territory 0200, Australia
| | - A Kubanek
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - M D Lukin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
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Goldman ML, Ghorob A, Eyre SL, Bodenheimer T. How do peer coaches improve diabetes care for low-income patients?: a qualitative analysis. Diabetes Educ 2013; 39:800-10. [PMID: 24168838 DOI: 10.1177/0145721713505779] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore the perspectives and roles of peer coaches, who are patients with diabetes trained to provide diabetes self-management support (DSMS) to other patients. METHODS A focus group and 17 qualitative semi-structured interviews were conducted with community-based peer coaches in San Francisco in order to better understand the process by which these coaches engaged with their patients. Transcripts were coded and analyzed using methods based on grounded theory to develop a theoretical model of peer coach roles. RESULTS Peer coaches play 3 principal roles in providing DSMS: advisor, supporter, and role model. While working with patients, peer coaches had different approaches to setting emotional boundaries and to allocating responsibility for implementing health behavior changes. Peer coaches were more consistent in how they sought resources from providers. Peer coaches also became empowered to better manage their own diabetes. CONCLUSION Peer coaches are a highly motivated potential workforce uniquely positioned to teach and empower patients by building trust through shared experiences. The variability in coaching styles suggests an inherent diversity among peer coaches that must be accounted for in future strategies for design, recruitment, training, and oversight of peer coaching programs.
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Affiliation(s)
- Matthew L Goldman
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Amireh Ghorob
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
| | - Stephen L Eyre
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Thomas Bodenheimer
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
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Sipahigil A, Goldman ML, Togan E, Chu Y, Markham M, Twitchen DJ, Zibrov AS, Kubanek A, Lukin MD. Quantum interference of single photons from remote nitrogen-vacancy centers in diamond. Phys Rev Lett 2012; 108:143601. [PMID: 22540792 DOI: 10.1103/physrevlett.108.143601] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Indexed: 05/31/2023]
Abstract
We demonstrate quantum interference between indistinguishable photons emitted by two nitrogen-vacancy centers in distinct diamond samples separated by two meters. Macroscopic solid immersion lenses are used to enhance photon collection efficiency. Quantum interference is verified by measuring a value of the second-order cross-correlation function g((2))(0)=0.35±0.04<0.5. In addition, optical transition frequencies of two separated nitrogen-vacancy centers are tuned into resonance with each other by applying external electric fields. An extension of the present approach to generate entanglement of remote solid-state qubits is discussed.
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Affiliation(s)
- A Sipahigil
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
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Kwon H, Thierry-Mieg D, Thierry-Mieg J, Kim HP, Oh J, Tunyaplin C, Carotta S, Donovan CE, Goldman ML, Tailor P, Ozato K, Levy DE, Nutt SL, Calame K, Leonard WJ. Analysis of interleukin-21-induced Prdm1 gene regulation reveals functional cooperation of STAT3 and IRF4 transcription factors. Immunity 2010; 31:941-52. [PMID: 20064451 DOI: 10.1016/j.immuni.2009.10.008] [Citation(s) in RCA: 287] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 07/08/2009] [Accepted: 10/08/2009] [Indexed: 11/25/2022]
Abstract
Interleukin-21 (IL-21) is a pleiotropic cytokine that induces expression of transcription factor BLIMP1 (encoded by Prdm1), which regulates plasma cell differentiation and T cell homeostasis. We identified an IL-21 response element downstream of Prdm1 that binds the transcription factors STAT3 and IRF4, which are required for optimal Prdm1 expression. Genome-wide ChIP-Seq mapping of STAT3- and IRF4-binding sites showed that most regions with IL-21-induced STAT3 binding also bound IRF4 in vivo and furthermore revealed that the noncanonical TTCnnnTAA GAS motif critical in Prdm1 was broadly used for STAT3 binding. Comparing genome-wide expression array data to binding sites revealed that most IL-21-regulated genes were associated with combined STAT3-IRF4 sites rather than pure STAT3 sites. Correspondingly, ChIP-Seq analysis of Irf4(-/-) T cells showed greatly diminished STAT3 binding after IL-21 treatment, and Irf4(-/-) mice showed impaired IL-21-induced Tfh cell differentiation in vivo. These results reveal broad cooperative gene regulation by STAT3 and IRF4.
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Affiliation(s)
- Hyokjoon Kwon
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
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Goldman ML, Denduluri N, Berman AW, Sausville R, Guadagnini JP, Kleiner DE, Brahim JS, Swain SM. A Novel Case of Bisphosphonate-Related Osteonecrosis of the Torus Palatinus in a Patient with Metastatic Breast Cancer. Oncology 2007; 71:306-8. [PMID: 17657174 DOI: 10.1159/000106451] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 11/18/2006] [Indexed: 11/19/2022]
Abstract
Bisphosphonates administered orally and intravenously are used for a variety of endocrine and oncologic indications. Long-term intravenous use of bisphosphonates has been shown to cause osteonecrosis of the jaw. We report a case in which a 58-year-old woman with metastatic breast cancer received 18 doses of 4 mg intravenous zoledronic acid over a period of 16 months and developed a region of osteonecrosis on the posterior edge of a large, lobular torus palatinus. Torus palatinus, a type of maxillary exostosis, is common among postmenopausal women, and is vulnerable to blunt trauma that could predispose to osteonecrosis. Sequestrum of dead bone was removed and the site healed within 4 weeks. This case demonstrates that patients with a torus palatinus may be at high risk for osteonecrosis, and reinforces the need for good oral hygiene and frequent dental examination while receiving bisphosphonate therapy.
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Affiliation(s)
- Matthew L Goldman
- Breast Cancer Section, Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md 20889, USA
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Easterling TR, Brateng D, Goldman ML, Strandness DE, Zaccardi MJ. Renal vascular hypertension during pregnancy. Obstet Gynecol 1991; 78:921-5. [PMID: 1833686] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report two women with renal artery stenosis in pregnancy. The first patient presented with severe hypertension in the first and second trimesters characterized by an extremely high vascular resistance (maximum 2455 dyne.second.cm-5). Transluminal angioplasty was performed at 20 weeks' gestation, resulting in resolution of the patient's hypertension. After angioplasty, her vascular resistance fell to 1600 dyne.second.cm-5, but did not reach normal pregnant levels. The pregnancy was carried to term without complication. The second patient's hypertension improved during pregnancy, and she delivered at term without complication. Twelve weeks postpartum, the patient again became severely hypertensive, and transluminal angioplasty was performed.
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Affiliation(s)
- T R Easterling
- Departments of Obstetrics and Gynecology, University of Washington, Seattle
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