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Background: Hospitals are increasingly engaging in partnerships to address population health in response to national policies, such as value-based payment models. However, little is known about how institutional factors influence hospital partnerships for population health. Purpose: Guided by institutional theory, we examine the association between institutional pressures (coercive, normative, and mimetic isomorphism) and hospital partnerships for population health. Methodology: A pooled cross-sectional analysis used an unbalanced panel of 10,777 hospital-year observations representing respondents to a supplemental question of the American Hospital Association's annual survey (2015–2017). The analysis included descriptive and bivariate statistics, and regression models that adjusted for repeated observations to examine the relationship between key independent variables and partnerships over time. Findings: In regression analyses, we found the most support for measures of coercive (e.g., regulatory factors) isomorphism, with nonprofit status, participation in accountable care organizations, and acceptance of bundled payments, all being consistently and significantly associated with partnerships across all organization types. Modest increases were observed from 2015 to 2017 for hospital partnerships with public health organizations (+2.8% points, p <.001), governmental organizations (+2.0% points, p =.009), schools (+4.1% points, p <.001), and businesses (+2.2% points, p =.007). Practice Implications: Our results suggest that institutional factors, particularly those related to regulatory policies and programs, may influence hospital partnerships to support population health. Findings from this study can assist hospital leaders in assessing the factors that can support or impede the creation of partnerships to support their population health efforts. [ABSTRACT FROM AUTHOR]

Mailing surveys to low-income populations is often avoided because of concern about low response rates. In this study, the authors used a mailed survey of a low-income population to test whether $1.00 or $2.00 cash-response incentives were worth the expense and whether 2-day priority mail ($2.90 postage) would yield a sufficiently higher response rate than certified mail ($1.52 postage) to justify its cost. In 1994, 2, 243 randomly selected families in subsidized health care programs in Pierce County, Washington, were randomly sent no incentive, $1.00, or $2.00 in the first of three mailings. For the third mailing, nonrespondents were randomly assigned to receive either certified or 2-day priority mail. After 4 weeks, the response rates were 36.7%, 48.1%, and 50.3% for the no-incentive, $1.00, and $2.00 groups, respectively. After three mailings, the cost per response was the lowest for the group that received $1.00. The response rate for the certified mailing (28.1%) was significantly higher than the rate for the more expensive priority mailing (21.7%). No incentive-related bias was detected. The authors concluded that the most efficient protocol for this low-income population was to use a $1.00 incentive in the first mailing and a certified third mailing. Am J Epidemiol 1999; 149:1057–62. [ABSTRACT FROM PUBLISHER]

Granting open access to new antipsychotic medications by the California Medicaid Program fostered the desired substitution of second-generation medications for conventional antipsychotics. However, open access also generated an immediate but temporary influx of previously treated patients, many with a recent institutionalization, who restarted drug therapy using the new antipsychotics. Persistence with initial therapy declined, but cost outcomes improved due primarily to reduced nursing home use. Racial disparities were also reversed. Program administrators must use caution when evaluating the impact of unrestricted access on drug therapy outcomes and treatment costs given the changes in the characteristics of patients seeking treatment. [ABSTRACT FROM AUTHOR]

This study compares the effects of atypical and conventional antipsychotic medications on treatment continuation and outcomes in a first admission sample of patients with schizophrenia treated in usual practice settings. In a sample of 189 participants with a research diagnosis of DSM-IV schizophrenia drawn from the Suffolk County Mental Health Project, we compared the effects of atypical and conventional agents on change of medication, medication gaps, and rehospitalization. For these analyses we used the method of survival analysis for recurrent events, in which the episodes of treatment rather than individual subjects are the units of analysis. In addition, we compared improvement in positive and negative symptoms from intake to 24- or 48-month followups for subjects who stayed on one type of medication or changed to atypicals from conventional antipsychotics. Atypical agents were associated with lower risk of medication change, medication gaps, and rehospitalization. Both conventional and atypical agents were associated with improvement of positive symptoms at followup, but only subjects on atypical agents at followup experienced a significant improvement in negative symptoms. We conclude that in usual practice settings, as in randomized clinical trials, atypical agents are associated with improved treatment continuation and outcomes. [ABSTRACT FROM PUBLISHER]

This article presents an analytic tool populated with data from published studies to illustrate the likely impacts of a switch from typical to atypical antipsychotic drugs over a 3-year period on individual, family, and societal outcomes for a U.S. schizophrenia population. Data taken from clinical trials and observational data studies are used. Changes in annual health care costs, schizophrenia symptom days, extrapyramidal symptom (EPS) days, suicide rates, and employment days are estimated. For each 1,000 people treated with typical drugs, the base case scenario gives estimates of annual medical care costs of $28.9 million with 80,253 moderate/severe schizophrenia symptom days and 92,006 EPS days. In the base case scenario, after switching to atypical drugs, schizophrenia symptom days are estimated to decrease up to 33 percent, EPS days up to 50 percent, and total medical care costs up to 19 percent over the 3-year period. Suicide rates fall and employment rates increase. The direction of the impacts remain the same for a wide range of input parameter values used in sensitivity analyses. Thus, switching to atypical drugs will likely reduce total medical care costs and decrease other disease burdens for people with schizophrenia, their families, and society. [ABSTRACT FROM PUBLISHER]

Evaluates the relationships between breech presentation and infant, maternal, and pregnancy characteristics of singleton births. Association of low birth weight, short gestational age, primiparity and older maternal age with increased risk of breech birth; Cross-ethnical comparison of the risk of breech presentation.

Cognitive impairments in schizophrenia appear to be associated with social problem solving, social and vocational functioning, and psychosocial skill acquisition. The present study examined the relationship of cognitive functioning, as well as clinical symptoms, to vocational outcomes among individuals with schizophrenia. One hundred and twelve participants with DSM-IV schizophrenia spectrum diagnoses underwent a comprehensive neuropsychiatric evaluation after enrolling in one of several employment programs. The neuropsychological evaluation examined verbal learning and memory, attention, speed of information processing, and executive functioning. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). Vocational outcomes were assessed 4 months after baseline assessment and included both measures of employment outcome (e.g., earnings) and of work performance as assessed by the Work Behavior Inventory (WBI). Negative symptoms, learning and memory performance, processing speed, and executive functioning were related to hours, weeks, and wages earned on the job. Stepwise multiple regression analyses found that among baseline clinical and cognitive predictors, only verbal learning and memory and cognitive disorganization symptoms were significant predictors of work behaviors 4 months later. Learning and memory were the only significant predictors of integrated employment at 4 months. These results suggest specific aspects of cognition may be modestly predictive of vocational outcomes. [ABSTRACT FROM AUTHOR]

Assessment is a core function of public health. Comprehensive clinical data may enhance community health assessment by providing up-to-date, representative data for use in public health programs and policies, especially when combined with community-level data relevant to social determinants. In this study we examine routinely collected and geospatially-enhanced EHR data to assess population health at various levels of geographic granularity available from a regional health information exchange. We present preliminary findings and discuss important biases in EHR data. Future work is needed to develop methods for correcting for those biases to support routine epidemiology work of public health.

Objective: To describe the prescription of antipsychotic agents in the United States and to investigate the association between demographic characteristics, clinical diagnosis, and antipsychotic prescribed., Methods: Four years (1997-2000) of data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Care Survey (NHAMCS) were combined for analysis. Distributions for patient age, race, gender, primary diagnosis, and provider's medical specialty were assessed. Logistic regression models were developed to estimate the probability of receiving either (1) a second-generation vs a first-generation antipsychotic, or (2) olanzapine vs risperidone, given differences in gender, race, age, and primary diagnosis., Results: Nearly 35.9 million ambulatory healthcare visits resulted in antipsychotic prescription during 1997-2000, or nearly 1% of all healthcare visits for the period. Nearly 30% of these visits were to nonpsychiatric physicians. The use of first-generation antipsychotics declined during this period, while the use of second-generation antipsychotics increased. Risperidone and olanzapine accounted for the majority of second-generation antipsychotic use. While the mean ages of patients using risperidone and olanzapine were similar, the age distributions differed, with risperidone showing more frequent use among the young (< 18 years) and the old (> 65 years). Patients of nonwhite race were more likely to receive olanzapine than risperidone., Conclusion: Results from this national survey indicate that second-generation antipsychotics are being used with increasing frequency and are widely used outside of the psychiatric specialty. Differences in age distribution, racial representation, and diagnostic representation are associated with drug selection, reinforcing the importance of accounting for case-mix factors when researching these antipsychotics in observational studies.