Health Services Research Commons^™

Seeing Recovery Through The Eyes Of Ethnic And Cultural Minorities, Linda M. Cabral, Kathy Muhr, Judith A. Savageau

Judith A. Savageau

Describes a study that sought to better understand how persons with mental health conditions from two cultural groups, Latino and Deaf/Heard of Hearing (D/HH), access recovery-oriented and peer support services. Results from this study helped to inform the Massachusetts Department of Mental Health regarding system improvements that could be made to better serve these populations.

Six-Month Mortality And Cardiac Catheterization In Non-St-Segment Elevation Myocardial Infarction Patients With Anemia, Wen-Chih Wu, Molly Waring, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: It is unknown how anemia influences the invasive management of patients with non-ST-segment elevation myocardial infarction (NSTEMI) and associated mortality. We investigated whether receipt of cardiac catheterization relates to 6-month death rates among patients with different severity of anemia. METHODS: We used data from the population-based Worcester Heart Attack Study, which included 2634 patients hospitalized with confirmed NSTEMI, from three percutaneous coronary intervention-capable medical centers in the Worcester (Massachusetts, U.S.A.) metropolitan area, during five biennial periods between 1997 and 2005. Severity of anemia was categorized using admission hematocrit levels: less than or equal to 30.0% (moderate-to-severe anemia), 30.1-39.0% (mild …

Insurance Status And Length Of Stay For Involuntarily Hospitalized Patients, William Fisher, Paul Barreira, Alisa Lincoln, Lorna Simon, Andrew White, Kristen Roy-Bujnowski, Marylou Sudders

Alisa Lincoln

General and private psychiatric hospitals are becoming increasingly common as sites for involuntary hospitalization. Unlike the public facilities that these settings are supplanting, these hospitals must pay strict attention to issues associated with reimbursement, insurance status, and managed care. This article examines the effects of insurance status on length of stay for involuntarily hospitalized patients in general and private hospitals in Massachusetts. Using a two-stage sampling procedure, data on episodes of involuntary hospitalization were gathered and assessed using multiple regression. The primary effect was found between patients with Medicare, who had the longest stays, and individuals who were uninsured, who …

The Family Networks Implementation Study, Susan Maciolek, Joanne Nicholson, Nicole Dube, Jodi Adams, Bernice Gershenson

Joanne Nicholson

Family Networks is a comprehensive system transformation initiative to redesign and integrate traditional categorical services across Massachusetts into local systems of care for children, youth, and families served by the child welfare system. The Family Networks Implementation Study, a partnership between the Massachusetts Department of Social Services and the University of Massachusetts Medical School, is a two-year study of the process of implementing local systems of care that began in January 2007, and will continue through December 2008. Presented at the 21th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base. Tampa, Florida, February …

Using Organizational Data To Create The Essential Context For System Transformation In Child Welfare, William Deveney, Joanne Nicholson

Joanne Nicholson

The Massachusetts Department of Social Services (MA/DSS) has 29 area offices organized in 6 regions; 74,651 consumers (39,913 are children < 18 years of age); 10,863 children and youth in placement; and 3,400 employees (FY2005; 2nd quarter).

A comprehensive system transformation initiative is underway, to shift from the traditional “adversarial” child protective model, and translate the core values of “child-driven,” “family-centered,” “community-focused,” “strength-based,” “committed to diversity/ cultural competence,” and committed to continuous learning” into an active child welfare agenda. The “learning organization” is the guiding framework.

Continuous Quality Improvement (CQI) is an interactive, iterative, participatory process that reflects change in organizational values, and catalyzes and guides improvements in policy and practice. Data drive CQI, obtained as framed …

The Massachusetts Family Networks Implementation Study, Susan Maciolek, Joanne Nicholson, Jodi Adams, Bernice Gershenson, Katherine Woolsey, Brenda Warren

Joanne Nicholson

Family Networks is a comprehensive systems transformation initiative to redesign and integrate traditional categorical services across the Commonwealth into local systems of care for children, youth, and families served by the child welfare system. The Family Networks Implementation Study, a partnership between the Massachusetts Department of Social Services (MA/DSS) and the University of Massachusetts Medical School, is a two-year study of the process of implementing local systems of care that began in January 2007, and will continue through December 2008. Findings from the Family Networks Implementation Study will inform MA/DSS strategic planning, system refinements, and the Family Networks outcomes evaluation. …

Family Options For Parents With Mental Illnesses: A Developmental, Mixed Methods Pilot Study, Joanne Nicholson, Karen Albert, Bernice Gershenson, Valerie Williams, Kathleen Biebel

Joanne Nicholson

OBJECTIVE: The objective of this paper is to provide a description of Family Options, a rehabilitation intervention for parents with serious mental illnesses and their children focusing on recovery and resilience, and to report the findings from a pilot study at 6-months post-enrollment for participating mothers. METHODS: A developmental design, and mixed quantitative and qualitative methods facilitate an in-depth understanding of Family Options and its impact on parents early in the implementation process. RESULTS: Participating families faced significant challenges, including long-term mental health conditions in adults, and emotional and behavioral difficulties in children. Data from mothers (n = 22) demonstrate …

Perceived Accessibility As A Predictor Of Youth Smoking, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

PURPOSE: Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. METHODS: This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the …

Trends And Outcomes Associated With Angiotensin-Converting Enzyme Inhibitors, Chyke Doubeni, Carol Bigelow, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Joel Gore, Jerry Gurwitz, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: Limited recent data are available describing the patterns of use of angiotensin converting enzyme inhibitor (ACEI) therapy in patients with acute myocardial infarction (AMI), particularly from the more generalizable population-based setting. The purpose of this study was to examine trends in the receipt of ACEIs and associated short-term outcomes in patients hospitalized with AMI in a large Northeastern community.

METHODS: We conducted a community-wide study of 7991 patients hospitalized with AMI in all metropolitan Worcester, Massachusetts, medical centers during 8 annual periods between 1990 and 2003.

RESULTS: Among all patients, 44% received ACEI therapy during their acute hospitalization. There …

Treatment Practices And Outcomes Of Patients With Established Peripheral Arterial Disease Hospitalized With Acute Myocardial Infarction In A Community Setting, Frederick Spencer, Darleen Lessard, Chyke Doubeni, Jorge Yarzebski, Joel Gore, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: There are little contemporary data available describing the hospital and long-term outcomes of patients with peripheral arterial disease (PAD) who are hospitalized with acute myocardial infarction (AMI). The objectives of our population-based study were to examine the hospital and long-term outcomes, as well as the use of different treatment practices, among patients with established PAD who were hospitalized with AMI. METHODS: The study sample consisted of 4480 patients hospitalized with AMI at all Worcester, Mass, medical centers in 4 alternate years between 1997 and 2003. RESULTS: Among the metropolitan Worcester residents hospitalized with AMI, 13.5% had a history of …

A 25-Year Perspective Into The Changing Landscape Of Patients Hospitalized With Acute Myocardial Infarction (The Worcester Heart Attack Study), Robert Goldberg, Frederick Spencer, Jorge Yarzebski, Darleen Lessard, Joel Gore, Joseph Alpert, James Dalen

Jorge L. Yarzebski

Over the past several decades, significant advances have been made in the primary and secondary prevention of coronary artery disease. However, effects of changing lifestyle and treatment practices on demographic and clinical profiles and on hospital outcomes of patients who present with acute myocardial infarction (AMI) have not been well characterized. We carried out a prospective population-based investigation of >25-year trends (1975 to 2001) in demographic and clinical characteristics, treatment practices, and hospital outcomes of patients who had been hospitalized with AMI. Residents of a metropolitan area (Worcester, Massachusetts) who had been hospitalized with validated AMI (n = 10,440) in …