Effect of Having a Usual Source of Care on Health Care Outcomes Among Children With Serious Emotional Disturbance

Witt, Whitney P.; Fullerton, Catherine A.; Chow, Clifton; Gokhale, Mugdha; Naeger, Sarah; Walsh, Christine

doi:10.1016/j.acap.2016.06.001

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…To control for surgical procedures, procedure codes were grouped as suggested by Grams et al . as major (ear-nose-throat, thoracic, cardiac, vascular, general, urology, orthopedic) 7 , minor (procedure labels including terms in supplemental table S1 , if not classified as major surgery)), or none.…”

Section: Methodsmentioning

confidence: 99%

The comparative risk of acute kidney injury of vancomycin relative to other common antibiotics

Gaggl

Pate

Stürmer

et al. 2020

Sci Rep

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The glycopeptide antibiotic vancomycin is a mainstay in the treatment of Gram-positive infection. While its association with acute kidney injury (AKI) has waxed and waned, recent data suggest nephrotoxicity, even as mono-therapy. Our study aimed to evaluate the 2-week risk of AKI after at least 3 days of intravenous vancomycin mono-therapy initiated within 5 days of hospitalization compared to other intravenous antibiotics used for similar indications. We used a new user-active comparator study design and identified patients with a first hospitalization during which they received vancomycin or comparator, from commercial claims based in the United States. We estimated incidence rates, hazard ratios using adjusted cox-regression models, and standardized mortality/morbidity ratio weighted cox-regression models. In the 32,997 patients vancomycin was used in 17% of patients and 129 cases of AKI were observed. Overall incidence of AKI was 9.3 (95% CI 0.78–1.22) per 100 person-years. The adjusted hazard ratio for vancomycin versus all other comparators was 0.74 (95% CI 0.45–1.21). Separate models for respective comparators resulted in hazard ratios below the null, except for vancomycin vs. cefazolin. Intravenous vancomycin mono-therapy does not increase the risk of AKI compared to other intravenous antibiotics used for similar indication in this cohort of hospitalized patients.

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Section: Methodsmentioning

confidence: 99%

The comparative risk of acute kidney injury of vancomycin relative to other common antibiotics

Gaggl

Pate

Stürmer

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…A successful transition to primary care may help to provide social support as youth emerge into adulthood. On the frontline of early detection and intervention, primary care providers can provide a gateway to specialty services, act as a “medical home” and an advocate for potentially vulnerable patients, offer continuity of care, promotion of healthy habits, prevention of chronic diseases, and are associated with decreased acute healthcare service utilization [ 32 – 35 ]. Young adults with lived experience, key members of our stakeholder advisory board, described commitments to school, work, and moving for college as major barriers to utilizing primary care and psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Yet private health insurers typically do not provide this level of care, though many youth in their system require it. Additionally, primary care and transitional planning remain under-utilized and under-emphasized in these models, though data indicate their benefits [ 34 , 35 ]. Additional research among transition-age youth with serious mental illnesses such as schizophrenia, bipolar disorders, and other psychotic disorders is needed.…”

Section: Discussionmentioning

confidence: 99%

Healthcare use in commercially insured youth with mental health disorders

Hugunin

Davis

Larkin

et al. 2022

BMC Health Serv Res

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Background The objective of this study is to describe age-related patterns of outpatient healthcare utilization in youth and young adults with mental health disorders. Method We used the IBM® MarketScan® Commercial Database to identify 359,413 youth and young adults (12–27 years) with a mental health disorder continuously enrolled in private health insurance in 2018. Exploratory analysis was used to describe patterns of outpatient healthcare use (e.g., primary, reproductive, mental health care) and therapeutic management (e.g., medication prescriptions, psychotherapy) by age. Period prevalence and median number of visits are reported. Additional analysis explored utilization patterns by mental health disorder. Results The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12–17 years used both outpatient mental health care and primary care, 53.1–59.7% of those aged 18–27 years did. Most 18–19-year-olds had a visit with an internal medicine or family medicine specialist, a minority had a pediatrician visit. The prevalence of medication management increased with age, while the prevalence of psychotherapy decreased. Conclusions Taken together, this descriptive study illustrates age-related differences in outpatient healthcare utilization among those with mental health disorders. Additionally, those with the most severe mental health disorders seem to be least connected to outpatient care. This knowledge can inform efforts to improve utilization of healthcare across the transition to adulthood.

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“…The authors speculated that youth with an outpatient connection and urgent or non-urgent concerns may have sought help in the ED because their outpatient providers directed or referred them there, or the ED was more accessible or responsive to immediate needs than the outpatient provider. In a study that bears on this issue, Witt et al ( 2017 ) found that for Medicaid-insured children and youth the existence of a “usual source” of ambulatory care was associated with lower behavioral health inpatient utilization and expenditures but trended toward higher behavioral health-related ED utilization and expenditures.…”

Section: Categories Of Informationmentioning

confidence: 99%

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

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Effect of Having a Usual Source of Care on Health Care Outcomes Among Children With Serious Emotional Disturbance

Cited by 8 publications

References 18 publications

The comparative risk of acute kidney injury of vancomycin relative to other common antibiotics

The comparative risk of acute kidney injury of vancomycin relative to other common antibiotics

Healthcare use in commercially insured youth with mental health disorders

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

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