Impact of a medical home model on costs and utilization among comorbid HIV-positive Medicaid patients.

Objectives: The Pennsylvania Chronic Care Initiative (CCI) was a statewide patient-centered medical home (PCMH) initiative implemented from 2008 to 2011. This study examined whether the CCI affected utilization and costs for HIV-positive Medicaid patients with both medical and behavioral health comorbidities.

Study Design: Nonrandomized comparison of 302 HIV-positive Medicaid patients treated in 137 CCI practices and 2577 HIV-positive Medicaid patients treated elsewhere.

Pennsylvania's Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities.

Background: The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011.

Objective: Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders.

Design: Analysis of Medicaid claims using difference-in-difference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices.

Quality of Diabetes Care Among Adult Medicaid Enrollees With Mental Disorders.

Objective: In light of the national trend toward integrating mental and general medical care, this study examined disparities in diabetes treatment among Medicaid recipients in a nonintegrated, managed care behavioral health carve-out system.

Methods: A retrospective study of Medicaid claims (July 2009-June 2010) compared quality of diabetes treatment among 21,015 patients with and without mental disorders.

Results: Presence of a mental disorder was associated with higher use of outpatient and primary care services for diabetes, lower rates of hospitalizations for diabetes, and higher odds of receiving three or more quality measures for diabetes care.

Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics.

Objective: This study examined the extent to which hospital and regional characteristics are associated with length of hospitalization among patients with serious mental illness.

Methods: Data from the Pennsylvania Health Care Cost Containment Council and 2006 American Hospital Association data were obtained. The sample consisted of 106 hospitals from which 45,497 adults with serious mental illness were discharged in 2006.

Implementing an E-prescribing system in outpatient mental health programs.

This study describes the implementation and evaluation of an electronic prescription ordering system and feedback report in three community-based mental health outpatient agencies and the usefulness of the system in improving psychiatrists' prescribing behavior. Using the e-prescribing system as a data collection tool, feedback on evidence based prescribing practices for patients diagnosed with schizophrenia spectrum disorder or major affective disorder was provided to agency directors and prescribers via a monthly report. The results of the project were that e-prescribing tools can be installed at a reasonable cost with a short start up period.

Antipsychotic treatment among youth in foster care.

Objective: Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth.

Patients And Methods: The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had ≥1 claim with a psychiatric diagnosis and ≥1 antipsychotic claim in 2003.

Use of HIV and psychotropic medications among persons with serious mental illness and HIV/AIDS.

Persons with serious mental illness (SMI) have higher rates of co-morbid HIV disorders compared to the general population. There are concerns that the SMI/HIV population may be receiving fewer HIV and psychotropic medications due to problems of access and concerns by providers associated with following complex medication regimes. The purpose of this study was to examine any disparity in medication treatment of the SMI/HIV population by comparing medication use and continuity of prescription fills to groups that had HIV or SMI only versus those with SMI/HIV.

Treatment disparities in Parkinson's disease.

We sought to identify racial disparities in the treatment of Parkinson's disease (PD). We identified 307 incident PD cases using Pennsylvania State Medicaid claims, and extracted claims for medications, physical therapy, and healthcare visits for the 6 months after diagnosis. After controlling for age, sex, and geography, African-Americans were four times less likely than whites to receive any PD treatment (odds ratio, 0.

Racial differences in the diagnosis of Parkinson's disease.

The objective of this cohort study was to determine the incidence of Parkinson's disease (PD) and the effects of race/ethnicity, other demographic characteristics, geography, and healthcare utilization on probability of diagnosis. The authors used the Pennsylvania state Medicaid claims dataset from 1999 to 2003 to identify newly diagnosed cases of PD among the 182,271 Medicaid enrolled adults age 40-65; 319 incident cases of PD were identified. The 4-year cumulative incidence of PD was 45 per 100,000; 54 per 100,000 among whites, 23 per 100,000 among African-Americans and 40 per 100,000 among Latinos (P < 0.

Sexually transmitted infection among adolescents receiving special education services.

Background: To estimate the relative risk of sexually transmitted infections (STIs) among children identified as having learning disabilities through the special education system.

Methods: This cross-sectional study used special education data and Medicaid data from Philadelphia, Pennsylvania, for calendar year 2002. The sample comprised 51,234 Medicaid-eligible children, aged 12-17 years, 8015 of whom were receiving special education services.

Monetary incentives in support of academic achievement: results of a randomized field trial involving high-achieving, low-resource, ethnically diverse urban adolescents.

Significant resources have been directed at understanding and alleviating the achievement gap in education. Most programs focused on this aim rely on a top-down approach, including funding for infrastructure improvement, curriculum development, class size, and teacher salaries. This article presents findings from a randomized field trial that evaluates a bottom-up approach in which high-achieving students of diverse racial and ethnic backgrounds from poor families are given monetary incentives to maintain their academic standing.

Psychosocial development in racially and ethnically diverse youth: conceptual and methodological challenges in the 21st century.

As the US population becomes more diverse in the 21st century, researchers face many conceptual and methodological challenges in working with diverse populations. We discuss these issues for racially and ethnically diverse youth, using Spencer's phenomenological variant of ecological systems theory (PVEST) as a guiding framework. We present a brief historical background and discuss recurring conceptual flaws in research on diverse youth, presenting PVEST as a corrective to these flaws.

Quantitatively determined survivin expression levels are of prognostic value in human gliomas.

Purpose: Survivin is a novel antiapoptotic gene that has been recently cloned and characterized. Its expression has been found to be of prognostic significance in several tumor types. This is the first study on the prognostic significance of survivin expression in human gliomas.