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Background: Bacterial vaginosis (BV) is a highly prevalent vaginal infection. Objectives: Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. Methods: Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. Results: An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. Conclusion and Relevance: The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary. [ABSTRACT FROM AUTHOR]

Background: Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. Methods: A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. Results: Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32–0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42–0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47–2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02–1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. Conclusion: Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions. [ABSTRACT FROM AUTHOR]

Objectives: To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. Methods: We used natural language processing and statistical text analysis on restricted‐access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race‐specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). Results: A classifier trained on an all‐race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race‐specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. Conclusions: This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color. [ABSTRACT FROM AUTHOR]

Objective: Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness.Methods: A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs.Results: For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02).Conclusions: Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness. [ABSTRACT FROM AUTHOR]

The U.S. with only 4% of the world's population, bears a disproportionate share of infections in the COVID-19 pandemic. To understand this puzzle, we investigate how mitigation strategies and compliance can work together (or in opposition) to reduce (or increase) the spread of COVID-19 infection. Building on the Oxford index, we create state-specific stringency indices tailored to U.S. conditions, to measure the degree of strictness of public mitigation measures. A modified time-varying SEIRD model, incorporating this Stringency Index as well as a Compliance Indicator is then estimated with daily data for a sample of 6 U.S. states: New York, New Hampshire, New Mexico, Colorado, Texas, and Arizona. We provide a simple visual policy tool to evaluate the various combinations of mitigation policies and compliance that can reduce the basic reproduction number to less than one, the acknowledged threshold in the epidemiological literature to control the pandemic. Understanding of this relationship by both the public and policy makers is key to controlling the pandemic. This tool has the potential to be used in a real-time, dynamic fashion for flexible policy options. Our methodology can be applied to other countries and has the potential to be extended to other epidemiological models as well. With this first step in attempting to quantify the factors that go into the "black box" of the transmission factor β, we hope that our work will stimulate further research in the dual role of mitigation policies and compliance. [ABSTRACT FROM AUTHOR]

Objective Patients and other stakeholders generally report high satisfaction with neuropsychological evaluations (NPEs), but no research has examined effects of cognitive, emotional, and other factors that often prompt evaluations. A prospective, quasi-experimental study was conducted to examine self-reported cognitive and psychiatric symptoms, self-efficacy, motivation, and satisfaction following a NPE. Method Participants from a neuropsychology clinic who were diagnosed with AD/HD and/or a DSM-IV mood disorder based on a NPE were included, and excluded if diagnosed with dementia or failure on performance validity tests. Results To examine whether a NPE with an interventional feedback session was associated with outcomes, changes from baseline to post-feedback session were examined with repeated-measures analysis of variance. Pearson correlations determined whether changes in hypothesized mechanisms (i.e. self-efficacy, goal importance and confidence ratings, and use of cognitive strategies) were related to changes in cognitive or psychiatric symptom severity. At follow-up, participants reported reductions in psychiatric (change in Brief Symptom Inventory depression: M  = -2.8, SD  = 4.4, range = −11 to 8, |${\eta}_p^2$| =.30; anxiety: M  = 3.2, SD  = 6.6, range = −21 to 10, |${\eta}_p^2$|  = .20) and cognitive symptoms (change in Multiple Ability Self-Report Questionnaire attention: M  = −0.3, SD  = 0.5, range = −1.6 to 0.5, |${\eta}_p^2$|  = .31; verbal memory: M  = −0.3, SD  = 0.5, range = −1.1 to 0.5, |${\eta}_p^2$|  = .24; language: M  = −0.4, SD  = 0.4, range = −1.3 to 0.4, |${\eta}_p^2$|  = .48), and improved cognition (change in Meta-Memory Questionnaire ability: M  = 4.4, SD  = 6.2, range = −10 to 16, |${\eta}_p^2$|  = .35; contentment: M  = 4.3, SD  = 4.5, range = −7 to 14, |${\eta}_p^2$|  = .49). Participants reported increased self-efficacy for general and evaluation-specific goals. Increased goal-specific self-efficacy was associated with large reductions in psychiatric symptoms. Conclusions Participants reported high levels of satisfaction with the NPE. Results support the clinical utility of NPE and feedback, and underscore the importance of individualized goal setting as part of the evaluation process. [ABSTRACT FROM AUTHOR]

Objective: This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities.Methods: The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models.Results: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01).Conclusions: Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment. [ABSTRACT FROM AUTHOR]

Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions. [ABSTRACT FROM AUTHOR]

Objective: A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ.Methods: Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies.Results: R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time. [ABSTRACT FROM AUTHOR]

The empirical literature on the impact of psychiatric disability on employment outcomes has consistently shown that individuals with psychiatric disabilities are more likely than those without to experience adverse labor market outcomes. One strategy invoked to address barriers to employment has been reasonable job accommodations, developed originally through the Americans With Disabilities Act legislation. However, little is known about the factors associated with the request for reasonable job accommodations among those with serious psychiatric disabilities. Data for this study come from a longitudinal multisite demonstration project funded by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. Accommodations were reported by individuals with serious mental health disabilities who became employed. Results from logistic regression analysis found that those who disclosed their disability to their employers, who were more severely disabled, and who had positive social relationships were more likely to request accommodations. This study advances our knowledge of the factors that influence the decision of individuals with serious mental health disabilities to seek accommodation in the work environment and offers a framework for guiding rehabilitation counselors in ways that might help to enhance employment outcomes for this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Two decades since the passage of the Americans with Disabilities Act in 1990, individuals with psychiatric disabilities continue to face barriers to employment that includes sensitivity to the benefit structure of the Supplemental Security Income (SSI). OBJECTIVE: This study examines cost-savings to the SSI program due to enhanced employment outcomes for persons with psychiatric disabilities associated with the receipt of job accommodations. METHODS: Data come from a federally funded, multi-site, implementation effectiveness study of supported employment models for 987 working age adults. Cost-savings were estimated using ordinary least squares regression to examine averted SSI payment. RESULTS: Accommodations were associated with a marginal monthly SSI savings of $ 11.73, and these savings were 68 percent higher compared to the non-accommodations group. Being married, having independent housing, and recent employment history predicted savings increases. Physical and emotional problems affecting work, a schizophrenia diagnosis, and symptoms of social withdrawal and blunted affect predicted lower savings. CONCLUSIONS: This study adds to a small body of literature examining the impact of accommodations for persons with psychiatric disabilities. Future work in this area might examine savings to the Social Security Disability Insurance program and should include factors unavailable in this analysis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to fill a gap in the literature on effectiveness of employment accommodations by comparing employment outcomes for individuals with psychiatric disabilities who received or did not receive accommodations, with models informed by a conceptual approach blending static labor supply theory, Sen's capability approach, and the International Classification of Functioning. Methods: Data for the study came from a longitudinal, four-year eight-state multisite demonstration project funded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. All participants had been recruited from clinical populations receiving outpatient psychiatric services. The effects of job accommodations on hours worked were assessed with generalized linear modeling (N= 1,538). The effects of job accommodations on duration of employment were assessed with a parametric duration model analysis (N=1,040) that incorporated multiple spells of employment among individuals over the study period. Results: Controlling for covariates suggested by the conceptual model, analyses showed that individuals who reported job accommodations on average worked 7.68 more hours per month and those who reported receiving accommodations worked 31% longer, with each job accommodation reported decreasing the risk of job termination by nearly 13%. Conclusions: Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients. [ABSTRACT FROM AUTHOR]

Objective: The authors evaluated the Substance Abuse and Mental Health Services Administration's mental health transformation state incentive grant program, which provided more than $100 million to nine states to make infrastructure changes designed to improve services and outcomes. Methods: The audiors measured infrastructure changes, service changes, and consumer outcomes in the nine programs. Although the federal program had no logic model, the audiors adopted a model diat hypothesized positive, but small, correlations between the program elements. Results: There were few statistically significant correlations and a number of negative correlations between infrastructure changes, service changes, and consumer outcomes. Conclusions: Federal investments should take into account evidence that infrastructure changes alone do not necessarily contribute to better consumer outcomes, support operationally defined infrastructure improvements, require that service improvements accompany infrastructure changes, and provide sufficient resources to oversee grantee behaviors. In addition, future evaluation should support evaluation best practices. [ABSTRACT FROM AUTHOR]

Integrated treatment of co-occurring substance use and mental health disorders is defined by the concurrent delivery of treatment for both disorders by a team of providers. This approach is designed to increase effectiveness by minimizing obstacles experienced by individuals who are seeking care for co-occurring disorders. This meta-analysis analyzed the results of several studies conducted in the United States to ascertain the effectiveness of integrated treatment on the discrete outcomes of drug use, alcohol use and psychiatric symptoms and functioning. This meta-analysis also examined the effect of integrated treatment in different settings (i.e. residential vs. outpatient). The meta-analysis systematically examined 13 studies (n = 2824) with similar methodologies and combined their results mathematically to ascertain a more precise assessment of treatment effect. The results indicated that integrated treatment created modest, non-statistically significant improvements in psychiatric outcomes and alcohol use when compared to treatment as usual. In contrast, the comparison treatment produced a significant effect on the reduction of drug use. Further examination of the effectiveness of integrated treatment in outpatient versus residential treatment settings revealed that the effectiveness of integrated care varies by setting. Limitations of the analysis are discussed along with suggestions for future research. The most significant contribution made by this analysis is the discovery of the variability of impact made by integrated care based on treatment setting (outpatient vs. residential). Because of the differences in treatment costs between residential and outpatient settings, these results have important policy implications. [ABSTRACT FROM AUTHOR]

Objective: Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction. Methods: Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared. Results: All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively). Conclusions: The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n=1,273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixed-effects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes. [ABSTRACT FROM AUTHOR]