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Background Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses. Methods Participants were adults with cooccurring disorders (n = 406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up. Results A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3 months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment. Conclusions These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.

Purpose The American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand developed candidate quality measures for potential inclusion in the Merit-Based Incentive Program and National Quality Forum in the hope that hand surgeons could report specialty-specific data. The following measures regarding the management of carpal tunnel syndrome (CTS) were developed using a Delphi consensus process: (1) use of magnetic resonance imaging (MRI) for diagnosis of CTS, (2) use of adjunctive surgical procedures during carpal tunnel release (CTR), and (3) use of formal occupational and/or physical therapy after CTR. This study simulated attempts to identify outlier regions in an insurance claims database, which is an important step in establishing feasibility of these measures. Methods Using the Truven Health MarketScan, we identified 643,357 patients who were given a diagnosis of CTS between 2012 and 2014. We reported the percentage of metropolitan statistical areas (MSA) with one or more claims for MRI within 90 days of CTS diagnosis, one or more adjunctive surgical procedures, and one or more formal referrals for physical and/or occupational therapy within 6 weeks of CTR, and we calculated the rate of use for each of these diagnostic or treatment modalities. In addition, we report the precision ratio (signal to noise), SD, and 95% confidence interval. Results A high percentage of patients given a diagnosis of CTS did not have MRI (99%), and the precision ratio was considered high (0.99). Over 30% of all observed MSAs had at least one claim for MRI as a diagnostic modality in CTS. Most patients (98%) did not have adjunctive surgical procedures. For the observed years, over 28% of MSAs had at least one insurance claim for an adjunctive procedure. A total of 86% of patients did not receive formal occupational or physical therapy after CTR. In addition, 92% of MSAs had at least one claim for therapy. The precision ratio was considered high (approximately 0.85). Conclusions There is regional variation in the utilization rate of diagnostic MRI for CTS, adjunctive surgical procedures, and formal referral for physical and occupational therapy. For the proposed quality measures, outlier regions can be detected in insurance claims data. Clinical relevance Use of MRI in diagnosis, adjunctive surgical procedures, and formal therapy after surgery are feasible quality measures for the Merit-Based Incentive Program and National Quality Forum.

Objective: Prehospital bypass policies were designed to encourage transport of eligible stroke patients to stroke centers in order to receive rapid assessment and treatment. In a national dataset we examined the relationship between implementation of bypass policies and the proportion of patients transported to stroke centers. Methods: We included EMS transported ischemic stroke patients aged 66+ from a 20% sample of Medicare claims (2007 - 2014). We excluded patients not admitted through the ED, and those not continuously enrolled in parts A/B in the prior year. The outcome measure was transport to PSC. Stroke certification status was validated by multiple stroke certification databases; policy implementation details were obtained from review of statutes and regulations. We employed difference-in-differences (DID) analyses with a state-level random intercept. Results: A total of 20,345 patients were included in the study with 7,239 from policy states and counties and 13,106 from non-policy states and counties. The proportion of patients arriving at PSCs increased from 28% to 43% in non-policy areas and 33% to 57% in policy areas. The DID analysis revealed a net effect of 11% (p Discussion: In pre-thrombectomy era, statewide prehospital bypass policies were related to significant increases in proportion of stroke patients transported to stroke centers. Future analyses will assess if these effects occur in the thrombectomy era, and if these policies influence delivery of stroke treatments.

INTRODUCTION AND OBJECTIVE:A plethora of risk prediction tools (RPTs) have been developed to support surgical decision-making. However, past studies indicate both limited uptake and minimal impact ...

INTRODUCTION AND OBJECTIVE:As most patients with prostate cancer die from a different cause, current guidelines recommend treatment only for patients expected to live more than 10 years. Subsequent...

INTRODUCTION AND OBJECTIVE:The overwhelming majority of patients diagnosed with prostate cancer will die from a competing cause. As a result, predicting mortality is an essential consideration in d...

INTRODUCTION AND OBJECTIVES:Big Data in healthcare amasses different types of information from multiple sources with the promise of improving healthcare delivery. However, the extent to which patie...

Despite the high prevalence of alcohol use disorders (AUDs), in a given year, only 12.1% of those meeting diagnostic criteria receive any treatment. Most individuals with AUDs are identified in primary care settings and referred to substance use disorders clinics, however only a minority attend treatment services. Developing options for treatment within primary care settings may increase receipt of services for AUDs. Safe and effective pharmacological treatments exist that could be integrated into primary care settings. This study will refine, implement and evaluate an intervention to integrate AUD treatment options, particularly pharmacological options, into primary care settings in three large Veterans Health Administration facilities. The current paper will present the implementation and evaluation strategies and the results of the developmental portion of the formative evaluation (FE). The implementation intervention targets multiple stakeholders: 1) substance use disorder and primary care mental health integration providers trained as local implementation leaders, 2) primary care providers who will have access to consultation, educational materials, a dashboard of patients with AUD on their caseload, and feedback on their prescribing practices, and 3) Veterans diagnosed with AUD who will receive educational mailings. Evaluation methods will combine FE with an interrupted time series to monitor change in facility level prescribing rate. The developmental FE consists of interviews with the local implementation leaders, primary care providers, and Veterans with AUD diagnoses. The Consolidated Framework for Implementation Research (CFIR) informed the development of the interview guides. Qualitative analysis will identify CFIR constructs that function as significant barriers and facilitators to implementation success and results will be used to refine the intervention plan. The findings will advance implementation science by demonstrating the use of theory to inform refinement of an implementation intervention and will contribute to accumulating knowledge regarding the relevance of specific CFIR constructs to implementation success.