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1.
Child Obes ; 16(7): 520-526, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32960095

RESUMO

Background: In 2007, an Expert Committee recommended that dietary patterns be assessed at each wellness visit and that counseling on diet and nutrition be provided to all children. Few studies have examined the "uptake" of obesity prevention practices into pediatric primary care. This study aimed to describe patterns of nutrition counseling among children at wellness visits in South Carolina between 2008 and 2017 and determine whether sociodemographic disparities existed. Methods: The sample included 123,864 children 2-18 years of age who had a wellness visit at one of South Carolina's four major health care systems between January 1, 2008, and December 31, 2017. Documentation of nutrition counseling was defined by the International Classification of Diseases (ICD)-9/10 codes. A matched sample design and conditional logistic regression were used to examine sociodemographic disparities in children who did and did not receive nutrition counseling. Results: Nutrition counseling was documented at 3.55% of wellness visits. Significant sociodemographic disparities were found, including that African American and Hispanic children were less likely to receive counseling than white or non-Hispanic children. Differences were also found by urban/rural residence, health insurance, and BMI. Despite guidelines, ICD 9/10 code indicating diagnosis of overweight or obesity was documented for only 12.2% of children. Conclusions: Nutrition counseling was rarely documented in a large sample of electronic medical record (EMR) data from pediatric wellness visits in South Carolina-a state heavily burdened by childhood obesity. Children's BMIs were infrequently recorded, which may be a barrier to tracking BMI over time. Sociodemographic and geographic differences in nutrition counseling may exacerbate disparities in childhood obesity.


Assuntos
Obesidade Infantil , Índice de Massa Corporal , Criança , Aconselhamento , Humanos , Sobrepeso , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , South Carolina/epidemiologia
2.
Int J Methods Psychiatr Res ; 28(3): e1788, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31373125

RESUMO

OBJECTIVES: Warrior Transition Units (WTUs) are specialized military units co-located with major military treatment facilities providing a Triad of Care involving primary care physicians, case managers, and military leadership to soldiers needing comprehensive medical care. We describe the rationale and methods for studying behavioral health care in WTUs and characterize soldiers assigned to WTUs. METHODS: The Army Warrior Care Project (AWCP) analyzes U.S. Department of Defense Military Health System data to examine behavioral health problems and service utilization among Army soldiers who were assigned to WTUs after returning from Afghanistan and Iraq deployments, FY2008-2015. RESULTS: WTU members (N = 31,094) comprised 3.5% of the AWCP cohort (N = 883,091). Almost all (96.5%) had one WTU assignment for a median of 327 days; 77.3% were assigned before deployment ended, ≤30 or >365 days post-deployment; 59.4% had deployment-related behavioral health diagnoses. CONCLUSIONS: An overwhelming majority of soldiers had one WTU assignment for almost a year. A substantial proportion of WTU soldiers had psychological impairment, which limited performance of their military duties. The AWCP is the first longitudinal study of redeployed soldiers assigned to WTUs and provides a unique opportunity to advance our understanding of behavioral health among soldiers needing comprehensive medical care after combat deployments.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde Militar/estatística & dados numéricos , Militares/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/organização & administração , Estados Unidos/epidemiologia , United States Department of Defense/estatística & dados numéricos , Adulto Jovem
3.
J Behav Health Serv Res ; 46(4): 549-569, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30627946

RESUMO

Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000-2002 (pre-deployment), 2003-2008 (first post-deployment), 2009-2014 (second post-deployment). Age was categorized: preschoolers (0-4 years), school-aged (5-11 years), adolescents (12-17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children's mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents' substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR = 2.93, 95% CI 1.86-4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR = 2.92, 95% CI 1.85-4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.


Assuntos
Comportamento do Adolescente/psicologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Adolescente , Campanha Afegã de 2001- , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Lactente , Guerra do Iraque 2003-2011 , Estudos Longitudinais , Masculino , Transtornos Mentais/psicologia , Militares , Gravidez , Estados Unidos/epidemiologia
4.
Mil Med ; 183(7-8): e278-e290, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29420772

RESUMO

Introduction: Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Materials and Methods: Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. Results: From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12-17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Conclusions: Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.


Assuntos
Medicina do Comportamento/economia , Serviços Terceirizados/normas , Adolescente , Adulto , Idoso , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Militares/psicologia , Militares/estatística & dados numéricos , Serviços Terceirizados/economia , Serviços Terceirizados/métodos , Psicometria/instrumentação , Psicometria/métodos
5.
J Healthc Qual ; 40(5): 256-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28933708

RESUMO

Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs). Over the study period, the proportion of hospital discharges with at least one HUE significantly decreased from 9.7% to 8.8%, including significant reductions in nine of the 14 HUEs. Academic, large, and urban hospitals had a significantly lower proportion of hospital discharges with at least one HUE in 2008, but only urban hospitals remained significantly lower by 2013. Results indicate that there has been a decrease in harm events captured through administrative coded data over this 6-year period. A composite measure, such as the WPMoS, is necessary for hospitals to evaluate their progress toward reducing preventable harm.


Assuntos
Hospitais Urbanos/normas , Erros Médicos/estatística & dados numéricos , Alta do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Segurança do Paciente/normas , Gestão da Segurança/estatística & dados numéricos , Gestão da Segurança/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , South Carolina , Adulto Jovem
6.
Health Serv Res ; 52(3): 1040-1060, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27678196

RESUMO

OBJECTIVE: To evaluate differences in hospital readmission risk across all payers in South Carolina (SC). DATA SOURCES/STUDY SETTING: South Carolina Revenue and Fiscal Affairs Office (SCRFA) statewide all payer claims database including 2,476,431 hospitalizations in SC acute care hospitals between 2008 and 2014. STUDY DESIGN: We compared the odds of unplanned all-cause 30-day readmission for private insurance, Medicare, Medicaid, uninsured, and other payers and examined interaction effects between payer and index admission characteristics using generalized estimating equations. DATA COLLECTION: SCRFA receives claims and administrative health care data from all SC health care facilities in accordance with SC state law. PRINCIPAL FINDINGS: Odds of readmission were lower for females compared to males in private, Medicare, and Medicaid payers. African Americans had higher odds of readmission compared to whites across private insurance, Medicare, and Medicaid, but they had lower odds among the uninsured. Longer length of stay had the strongest association with readmission for private and other payers, whereas an increased number of comorbidities related to the highest readmission odds within Medicaid. CONCLUSIONS: Associations between index admission characteristics and readmission likelihood varied significantly with payer. Findings should guide the development of payer-specific quality improvement programs.


Assuntos
Hospitais , Revisão da Utilização de Seguros/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , South Carolina , Estados Unidos
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