The role of health information technology in advancing care management and coordination in accountable care organizations.

Background: To be successful, accountable care organizations (ACOs) must effectively manage patient care. Health information technology (HIT) can support care delivery by providing various degrees of coordination. Few studies have examined the role of HIT functionalities or the role of different levels of coordination enabled by HIT on care management processes.

Using health information technology to manage a patient population in accountable care organizations.

Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities.

Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment.

Purpose Of Review: This review examines recent literature on the psychosocial needs of and interventions for young women. We focus on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. This review summarizes research relevant to addressing their social and emotional concerns.

Does co-morbid depression impact diabetes related costs? Evidence from a cross-sectional survey in a low-income country.

Aims Of The Study: The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania.

Quality of life of Latina and Euro-American women with ductal carcinoma in situ.

Background: Risk factors for psychosocial distress following a breast cancer diagnosis include younger age, history of depression, inadequate social support, and serious comorbid conditions. Although these quality of life (QOL) concerns have been studied in women with ductal carcinoma in situ (DCIS), Latina women have been understudied.

Methods: Data were from a cross-sectional telephone survey of Latina and Euro-American women with DCIS recruited through a population-based cancer registry.

Quality of life of younger breast cancer survivors: persistence of problems and sense of well-being.

Objective: Ten years after diagnosis, women diagnosed with breast cancer at age 50 or younger were assessed to determine whether quality of life (QOL) problems found at five years persisted. We predicted that QOL in the physical and social domains would be poorer, but improvements would be found in the psychological domain.

Methods: We re-interviewed 312 women, who had been interviewed at their five year anniversary and remained cancer free, on their QOL in three domains (physical, social, and psychological).

Capitation of public mental health services in Colorado: a five-year follow-up of system-level effects.

Objective: Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs.

Methods: Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999).

Social support and survival in young women with breast carcinoma.

Purpose: Although previous evidence has shown increased likelihood for survival in cancer patients who have social support, little is known about changes in social support during illness and their impact on survival. This study examines the relationship between social support and survival among women diagnosed with breast carcinoma, specifically assessing the effect of network size and changes in social contact post-diagnosis.

Methods: A population-based sample of 584 women was followed for up to 12.

Post-treatment regret among young breast cancer survivors.

Objective: The study addresses: (1) what women regret about their breast cancer treatment 5 years later, and (2) what characteristics of disease and treatment predict post-treatment regret.

Method: Interviews were conducted with breast cancer survivors in the San Francisco Bay Area. Participants were interviewed following diagnosis.

Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change?

Background: Today, the 5-year relative survival rate for cancer is 65% and there are 10.5 million survivors. The largest group of survivors are those of breast cancer.

Improving the health and well-being of cancer survivors: past as prologue.

During the past two decades, there have been a number of unsuccessful replication attempts of our finding that group psychotherapy improves cancer survival. One explanation for this failure is that the wrong phenomenon has been studied. Rather than focusing on the effects of the psychotherapeutic relationship, perhaps, the focus should have been on the social support provided and networks developed by these groups.

Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service.

Objective: To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models.

Data Sources/study Setting: The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for-profit managed behavioral health organization (MBHO).

Mammographic screening in women at increased risk of breast cancer after treatment of Hodgkin's disease.

Treatment regimens for Hodgkin's disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age.

Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors.

Survival from cancer has improved over the past decade resulting in more long-term survivors. The literature on multi-dimensional quality of life (QOL) among long-term (5+ years) adult survivors is reviewed for each of seven cancer sites (i.e.

Capitation and racial and ethnic differences in use and cost of public mental health services.

This study investigated racial and ethnic differences in the probability of mental health service use and costs of treatment before and after the implementation of capitated financing. Models were created to test effects on utilization and costs of African American, Latinos, and white mental health consumers. As service use and costs declined under capitation, Latino, and white levels of use and cost tended to converge.

Social networks and their relationship to mental health service use and expenditures among Medicaid beneficiaries.

Objective: This study examined the relationship between social networks and mental health services utilization and expenditures.

Methods: A sample of 522 Medicaid mental health consumers was randomly selected from the administrative records of Colorado's Department of Health Care Policy and Financing. The administrative records contain information on utilization of services and expenditures of Medicaid beneficiaries within Colorado's Mental Health Services.

Family history, perceived risk, and prostate cancer screening among African American men.

Background: Many African American men have two major risk factors for prostate cancer. By ethnicity alone, they have twice the risk of Euro-American men of developing prostate cancer. Having a family history (brother or father with prostate cancer) also doubles their risk.

Organizational and individual factors affecting consumer outcomes of care in mental health services.

The impact of organizational and individual factors on outcomes of care were assessed for 424 adult consumers with chronic mental illness who were receiving services from one of 14 Community Mental Health Organizations (CMHOs) in Colorado over a 30-month period, as part of a larger statewide evaluation of the impact of Medicaid capitation on mental health services. Data on organizational culture and climate were aggregated from surveys of staff and administrators conducted within CMHOs over a two-year period corresponding to the collection of consumer outcome and service utilization data. Growth curve analyses were conducted on consumer perceptions of physical and mental health, and on quality of life (QOL).

Effects of a telephone counseling intervention on sisters of young women with breast cancer.

Objective: Women that have a first-degree relative diagnosed with breast cancer at an early age are at increased risk of the disease, yet they often lack information about their personal risk of breast cancer and early detection measures. An intervention to provide objective risk information, reduce worries, and promote screening and healthy behaviors was developed.

Method: In 1999-2002, a randomized pre-post design was used to test a tailored telephone counseling intervention with a sample of 163 women whose sisters were diagnosed with breast cancer at age 50 or younger in the San Francisco Bay Area.

Breast cancer screening in women surviving Hodgkin disease.

Objective: To inform female Hodgkin disease (HD) survivors, younger than 35 at diagnosis, of their increased risk for breast cancer and encourage them to seek breast cancer screening.

Methods: An evidence-based intervention, telephone counseling, was used in a pre-post test design, randomized trial with the control group being offered the intervention following the post-test. Women treated at Stanford University who received thoracic irradiation before age 35, alive and HD-free at last contact, were referred to the project (n = 471).

Body image and sexual problems in young women with breast cancer.

Purpose: The purpose of this study was to determine the frequency of body image and sexual problems in the first months after treatment among women diagnosed with breast cancer at age 50 or younger.

Background: Breast cancer treatment may have severe effects on the bodies of younger women. Surgical treatment may be disfiguring, chemotherapy may cause abrupt menopause, and hormone replacement is not recommended.

Medication treatment patterns for adults with schizophrenia in Medicaid managed care in Colorado.

Objective: This study investigated the impact of Colorado's Medicaid mental health managed care program on patterns of antipsychotic medication treatment among persons with a diagnosis of schizophrenia. These patterns were compared with patterns of psychosocial treatment and a measure of symptom change.

Methods: Changes in study measures over time in two areas of the state where the policy intervention was implemented were compared with changes in measures in areas where it was not implemented.

The impact of capitated financing on psychiatric emergency services.

Objective: Studies of capitated financing of mental health services have generally focused on the cost and utilization of services. Relatively little research has addressed whether capitation has an impact on the effectiveness of the mental health system as a whole. This study examined the impact of capitation on hospital emergency department visits, a widely cited indicator of the effectiveness of the other components of the system.

Variation in outpatient mental health service utilization under capitation.

Background: To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services.

Study Aims: This study assessed outpatient service delivery to Medicaid-eligible consumers under this program.

Depression experienced by young women newly diagnosed with breast cancer.

Breast cancer is the most common type of cancer among women. While almost a quarter of women diagnosed with breast cancer are 50 or younger, few studies are focused on them. Compared to older women, young women have more difficulty adjusting to the breast cancer diagnosis, report more symptoms of distress and a lower quality of life.