1,561 results match your criteria: "Cecil G. Sheps Center for Health Services Research[Affiliation]"

Death ORACL: An Algorithm to Predict Death Using Insurance Claims Data.

Am J Epidemiol

September 2024

Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599.

The inability to identify dates of death in insurance claims data is the United States is a major limitation to retrospective claims-based research. While deaths result in disenrollment, disenrollment can also occur due to changes in insurance providers. We created an algorithm to differentiate between disenrollment from health plans due to death and disenrollment for other reasons.

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Patient-centered outcomes research helps youth and families using behavioral health services make informed decisions about treatments to help them achieve the outcomes most important to them. However, there are few efforts to identify the outcomes valued by youth and families systematically. This project aimed to support the development of behavioral health services that deliver outcomes valued by families by identifying the outcomes that youth and young adults with behavioral health needs and caregivers say matter most to them.

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Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children.

Psychiatr Serv

September 2024

Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy, Chapel Hill (Thomas, Annis, Davis, Hughes); UNC Cecil G. Sheps Center for Health Services Research, Chapel Hill (Thomas, Hughes); Departments of Pediatrics (deJong, Christian) and Psychiatry (Christian), UNC School of Medicine, Chapel Hill; Parent Advisory Group, UNC Eshelman School of Pharmacy, Chapel Hill (B. A. Prichard, J. R. Prichard, Allen, Gettinger, Morris, Eaker).

Objective: The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care.

Methods: Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period.

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Assessing proposals to update established screening strategies.

BMJ Evid Based Med

September 2024

Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.

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Hazard Ratios and Alternative Effect Measures: An Applied Illustration.

Pharmacoepidemiol Drug Saf

September 2024

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Purpose: Although the limitations of hazard ratios (HRs) for quantifying treatment effects in right-censored data have been widely discussed, HRs are still preferentially reported over other, more interpretable effect measures. This may stem from the fact that there are few applied examples that directly contrast the HR and its interpretation with alternative effect measures.

Methods: We analyzed data from two randomized clinical trials comparing panitumumab plus standard-of-care chemotherapy (SOCC) with SOCC alone as first- and second-line treatment for metastatic colorectal cancer.

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Objectives: To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight.

Design: Randomized crossover trial. The intervention consisted of 3 custom-designed linear arrays of amber light-emitting diodes (LEDs) arranged in strips: 1 strip aligned horizontally across the top of the bathroom/entry doorframe containing 68 LEDs and 2 strips of 140 LEDs each aligned vertically down the sides of the doorframe.

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Objective: Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health.

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Expanded Child Tax Credit and Food Insecurity.

JAMA Intern Med

October 2024

Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

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In Reply to "Pulse of Prudence: Navigating Isolated Lung Ultrasound in Hemodialysis Patients".

Kidney Med

August 2024

University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC.

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Atypical Antipsychotics and the Risk of Sudden Cardiac Death among Individuals Receiving Maintenance Hemodialysis.

Gen Hosp Psychiatry

August 2024

Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, USA.

Objective: Individuals receiving hemodialysis have high rates of sudden cardiac death (SCD). This study characterized oral atypical antipsychotic use and compared the cardiac safety of atypical antipsychotics with QT prolongation FDA warnings to that of atypical antipsychotics without such warnings among outpatients receiving hemodialysis.

Methods: Data for this active-comparator, new-user cohort study were obtained from the U.

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Understanding the potential for, direction, and magnitude of uncontrolled confounding is critical for generating informative real-world evidence. Many sensitivity analyses are available to assess robustness of study results to residual confounding, but it is unclear how researchers are using these methods. We conducted a systematic review of published active comparator cohort studies of drugs or biologics to summarize use of sensitivity analyses aimed at assessing uncontrolled confounding from an unmeasured variable.

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Background: People with disabilities are more likely to experience intimate partner violence (IPV) than those without. Most research examining the relationship between disability and IPV, however, is cross-sectional and approaches disability as a binary variable. This relationship is also important to consider in a South Asian context, where it may be affected by cultural norms surrounding IPV, and resources for people with disabilities.

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Introduction: There are long-standing differences in profitability between rural and urban hospitals. Prior to the COVID-19 Public Health Emergency (PHE), rural hospital profitability was decreasing, while urban hospital profitability was increasing. During the PHE, the Federal Government provided billions of dollars of support to hospitals.

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Behavioral Health Workforce Distribution in Socially Disadvantaged Communities.

J Behav Health Serv Res

January 2025

Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, UNC Behavioral Health Workforce Research Center, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA.

This study sought to understand the geographic distribution of three behavioral health clinician (BHC) types in disadvantaged communities in the U.S. across a standardized index of area disadvantage.

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Background And Objectives: Integrated behavioral health (IBH) delivered in primary care is critical to addressing the growing behavioral health crisis in the United States. COVID-19 prompted changes to the core components of IBH, causing the model to shift. The specifics of how IBH teams adapted and what these adaptations mean for the future of IBH teams in primary care are uncertain.

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Key Points: Plasmapheresis is recommended for treating ANCA-associated vasculitis with severe renal and/or lung involvement. We established the cohort being admitted for ANCA-associated vasculitis with active kidney involvement from the 2016–2020 National Inpatient Sample. We described characteristics, inpatient procedures, lengths of stay, hospital costs, and disposition for patients treated with plasmapheresis.

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This study assessed communication factors influencing shared decision-making (SDM) between language-congruent clinicians and Latina mothers of pediatric mental health patients. The sample comprised Latinx youth up to 22 years old who were enrolled in mental healthcare and attended mental health-related sessions with their parent. One hundred transcripts depicting mental health visits were coded using the Conversation Analysis framework.

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Trends in Continuation of Long-Acting Reversible Contraception Among Adolescents Receiving Medicaid.

J Adolesc Health

September 2024

Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's National, Washington, D.C.

Purpose: Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use.

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To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication.

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Improving young patient - practitioner communication about sexual health during medical visits.

Int J Adolesc Med Health

August 2024

Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Objectives: Young people face barriers that lead to gaps in sexual and reproductive health care communications. Issues such as discomfort discussing sexual health lead to inadequate delivery of services resulting in unintended pregnancies and STIs. Closing this communication gap between patients and health care practitioners would improve communication and health outcomes.

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The Prevalence and Benefits of Self-Compassion Among Professional Caregivers.

J Am Med Dir Assoc

August 2024

The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Objective: Self-compassion is a healthy way of responding to challenges that may help long-term care professional caregivers (ie, nursing assistants and personal care aides) cope with stress, but its use may vary in important ways. This study explored the relationships between self-compassion and caregiver demographic characteristics, anxiety and depressive symptoms, and job satisfaction in a large racially/ethnically diverse sample of professional caregivers.

Design: Cross-sectional self-report questionnaire.

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