Literature Collection

BACKGROUND: Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. OBJECTIVE: Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. PARTICIPANTS: States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. APPROACH: Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. RESULTS: A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. CONCLUSIONS: Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.

OBJECTIVE: This study examined whether documented disparities in access to behavioral health specialty care persisted in a novel integrated primary care model situated in a large health system when triage and referral management supports were provided by a centralized resource center for patients with behavioral health needs. METHODS: Patients triaged and referred to specialty behavioral health care who did or did not attend a specialty care visit (N=1,450) were compared in terms of various demographic and clinical characteristics by using binary logistic regression. RESULTS: Among patients with attendance data, financially unstable individuals were more likely than financially stable counterparts to miss their first appointment with a specialty behavioral health provider after referral from primary care. Previously documented attendance disparities based on race, ethnicity, and illness severity were not observed. CONCLUSIONS: These findings can inform targeted strategies to increase attendance among patients with financial insecurity and reduce disparities in outpatient behavioral health services.

OBJECTIVE: Child psychiatry access programs (CPAPs) help increase access to mental health services. This study aimed to provide information on the types of pediatric primary care clinicians (PPCCs) who call Maryland's CPAP. METHODS: Descriptive statistics and multinomial logistic regressions were conducted with data from 676 PPCCs who called Maryland's CPAP at least once between October 2012 and June 2019. RESULTS: On average, PPCCs contacted Maryland's CPAP 6.8 times. Providers who called seven or more times were more likely to have an allopathic or osteopathic medicine degree and to specialize in pediatrics. Providers calling from rural regions were less likely to call only for referrals. CONCLUSIONS: Most PPCCs contacted the CPAP for consultation or referrals but not both. PPCCs in rural areas were more likely to call for consultation, suggesting that they may be more likely to manage the care of patients with mental health conditions themselves, because of a lack of resources in their locations.

BACKGROUND: Substance use disorders (SUD) and mental health disorders (MHD) are major health concerns during the perinatal period (conception to one year postpartum). However, many individuals with perinatal SUD or MHD do not receive adequate treatment, and most treatment facilities do not offer services tailored to this population's unique needs. This study examines the proportion of treatment facilities in the United States (US) providing perinatal services, as well as facility- and state-level factors associated with offering such services. METHODS: Data were drawn from the 2022 National Substance Use and Mental Health Services Survey, an annual cross-sectional survey of all known public and private SUD and MHD treatment facilities in the US. The sample consisted of 6995 facilities providing SUD treatment (SUD-only) and 9134 facilities offering combined SUD and MHD treatment. Descriptive statistics, bivariate analyses, and multilevel logistic regression models examined treatment facility characteristics and the impact of facility- and state-level factors on the likelihood of offering perinatal services. RESULTS: Only 32.7% of SUD-only treatment facilities and 31.1% of combined SUD/MHD treatment facilities offered perinatal programs. More than half of these treatment facilities provided services critical to the perinatal population, including transportation assistance, social service support, trauma-informed therapy, and telehealth. Payment type (i.e., Medicaid acceptance, offer of free or low-cost treatment), for-profit treatment facility ownership, and receipt of state and federal grant funding were associated with a significantly increased likelihood of the treatment facility providing perinatal services. CONCLUSIONS: Findings indicate there is a pressing need for SUD and MHD treatment facilities to expand their services to include care for individuals in the perinatal period, as well as increase the availability of essential services (e.g., integrated primary care) and ancillary services (e.g., childcare). Further research is needed to understand at which timepoint(s) facilities provide treatment (i.e., pregnancy and/or the postpartum period) and which types of essential and ancillary services are most beneficial during the perinatal period.

INTRODUCTION: Hospital-based violence intervention programs (HVIPs) have emerged nationwide to help address the societal and economic costs of violence. Little literature exists regarding selecting those patients most likely to benefit from intensive case management. The study aims to describe the pediatric patient population presenting at a Level 1 ACS trauma center with a chief complaint of violent trauma and identify the characteristics of patients most at risk. METHODS: This retrospective study examined patients between the ages of eight- and nineteen-years old presenting with traumatic injury during the year 2019. Child abuse and non-accidental trauma patients were excluded. RESULTS: A total of 333 patients were included in the analysis. They were predominantly African American and male. The three-group design included those 8-11, 12-13, and 14-19 years. Most patients were over 14 years old (60.2%). "Classmates" was the most common relationship between assailant and victim overall (33.9%) and most prevalent in the youngest age group (8-11 year). The middle age group (12-13 year) were two times more likely to suffer from ADHD, and ADHD was a risk factor for self-harm in this age category. The oldest age group (14-19 year) suffered higher rates of gun violence and were attacked more often by unknown assailants. CONCLUSIONS: There was a difference in the needs of the older and younger pediatric patients cared for. HVIPs should tailor their interventions to address the different age groups' needs. HVIPs could also benefit from the integration of targeted mental health services and collaboration with local educational institutions.