Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review.

This systematic literature review investigates the use of technology for the coordination and management of mental health care with an emphasis on outcomes. Searches of MEDLINE/PubMed, Scopus, and EMBASE were conducted between January 1, 2003, and January 4, 2018, to identify articles that assessed patient outcomes associated with care coordination, evaluated technology to improve care, or discussed management of mental health care using technology. A total of 21 articles were included in a qualitative review based on the recommendations set forth by the PRISMA statement. Among the various health technologies, electronic health records were most commonly used for care coordination, with primary care being the most frequent setting. Care coordination was shown to provide easier patient access to health care providers and to improve communication between caregiver and patient, especially in cases where geographic location or distance is a challenge. Barriers to coordinated care included, but were not limited to, insufficient funding for health information technology, deficient reimbursement plans, limited access to technologies, cultural barriers, and underperforming electronic health record templates. In conclusion, many studies showed the benefit of coordinated and collaborative care through the use of technology; however, further research and development efforts are needed to continue technological innovation for advanced patient care.

Predicting Future High-Cost Schizophrenia Patients Using High-Dimensional Administrative Data.

BACKGROUND: The burden of serious and persistent mental illness such as schizophrenia is substantial and requires health-care organizations to have adequate risk adjustment models to effectively allocate their resources to managing patients who are at the greatest risk. Currently available models underestimate health-care costs for those with mental or behavioral health conditions. OBJECTIVES: The study aimed to develop and evaluate predictive models for identification of future high-cost schizophrenia patients using advanced supervised machine learning methods. METHODS: This was a retrospective study using a payer administrative database. The study cohort consisted of 97,862 patients diagnosed with schizophrenia (ICD9 code 295.*) from January 2009 to June 2014. Training (n = 34,510) and study evaluation (n = 30,077) cohorts were derived based on 12-month observation and prediction windows (PWs). The target was average total cost/patient/month in the PW. Three models (baseline, intermediate, final) were developed to assess the value of different variable categories for cost prediction (demographics, coverage, cost, health-care utilization, antipsychotic medication usage, and clinical conditions). Scalable orthogonal regression, significant attribute selection in high dimensions method, and random forests regression were used to develop the models. The trained models were assessed in the evaluation cohort using the regression R2, patient classification accuracy (PCA), and cost accuracy (CA). The model performance was compared to the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. RESULTS: At top 10% cost cutoff, the final model achieved 0.23 R2, 43% PCA, and 63% CA; in contrast, the CMS-HCC model achieved 0.09 R2, 27% PCA with 45% CA. The final model and the CMS-HCC model identified 33 and 22%, respectively, of total cost at the top 10% cost cutoff. CONCLUSION: Using advanced feature selection leveraging detailed health care, medication utilization features, and supervised machine learning methods improved the ability to predict and identify future high-cost patients with schizophrenia when compared with the CMS-HCC model.

Certification of Imaging Informatics Professionals (CIIP): 2010 survey of diplomates.

The Certification for Imaging Informatics Professionals (CIIP) program is sponsored by the Society of Imaging Informatics in Medicine and the American Registry of Radiologic Technologists through the American Board of Imaging Informatics. In 2005, a survey was conducted of radiologists, technologists, information technology specialists, corporate information officers, and radiology administrators to identify the competencies and skill set that would define a successful PACS administrator. The CIIP examination was created in 2007 in response to the need for an objective way to test for such competencies, and there have been 767 professionals who have been certified through this program to date. The validity of the psychometric integrity of the examination has been previously established. In order to further understand the impact and future direction of the CIIP certification on diplomats, a survey was conducted in 2010. This paper will discuss the results of the survey.

Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity.

OBJECTIVE: Most studies of contrast-induced nephropathy lack controls to distinguish it from nephropathy from other causes. We assessed the frequency and magnitude of serum creatinine changes in patients not receiving iodinated contrast material to compare with creatinine changes in publications regarding contrast nephropathy. MATERIALS AND METHODS: From the electronic medical records of an academic medical center, adults with creatinine determinations on five consecutive days who had not received contrast material during the previous 10 days were identified. The first creatinine level was compared with those on subsequent days. We calculated the frequency with which these levels exceeded thresholds used to identify contrast nephropathy in previous publications. RESULTS: Among 32,161 patients, more than half showed a change of at least 25% and more than two fifths, a change of at least 0.4 mg/dL. Among patients with baseline creatinine levels of 0.6-1.2 mg/dL, increases of at least 25%, 33%, and 50% occurred in 27%, 19%, and 11% of patients, respectively. Increases of 0.4, 0.6, and 1.0 mg/dL occurred in 13%, 7%, and 3% of patients. Among patients with baseline creatinine levels greater than 2.0 mg/dL, increases of at least 25%, 33%, and 50% occurred in 16%, 12%, and 7%. Increases of 0.4, 0.6, and 1.0 mg/dL occurred in 33%, 26%, and 18%. These increases were not different from the incidences of contrast nephropathy previously published. CONCLUSION: The creatinine level increases in patients who are not receiving contrast material as often as it does in published series of patients who are receiving contrast material. The role of contrast material in nephropathy may have been overestimated.

Determinants of S. cerevisiae dynein localization and activation: implications for the mechanism of spindle positioning.

BACKGROUND: During anaphase in budding yeast, dynein inserts the mitotic spindle across the neck between mother and daughter cells. The mechanism of dynein-dependent spindle positioning is thought to involve recruitment of dynein to the cell cortex followed by capture of astral microtubules (aMTs). RESULTS: We report the native-level localization of the dynein heavy chain and characterize the effects of mutations in dynein regulators on its intracellular distribution. Budding yeast dynein displays discontinuous localization along aMTs, with enrichment at the spindle pole body and aMT plus ends. Loss of Bik1p (CLIP-170), the cargo binding domain of Bik1p, or Pac1p (LIS1) resulted in diminished targeting of dynein to aMTs. By contrast, loss of dynactin or a mutation in the second P loop domain of dynein resulted in an accumulation of dynein on the plus ends of aMTs. Unexpectedly, loss of Num1p, a proposed dynein cortical anchor, also resulted in selective accumulation of dynein on the plus ends of anaphase aMTs. CONCLUSIONS: We propose that, rather than first being recruited to the cell cortex, dynein is delivered to the cortex on the plus ends of polymerizing aMTs. Dynein may then undergo Num1p-dependent activation and transfer to the region of cortical contact. Based on the similar effects of loss of Num1p and loss of dynactin on dynein localization, we suggest that Num1p might also enhance dynein motor activity or processivity, perhaps by clustering dynein motors.