The Administrative Psychiatric Evaluation.
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ABSTRACT:
SUBMITTER: Lawson ND
PROVIDER: S-EPMC4763376 | biostudies-literature | 2016 Feb
REPOSITORIES: biostudies-literature
Publications
The Administrative Psychiatric Evaluation.
Lawson Nicholas D ND Kalet Adina L AL
Journal of graduate medical education 20160201 1
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Project description:There is a very high suicide rate in the year after psychiatric hospital discharge. Intensive postdischarge case management programs can address this problem but are not cost-effective for all patients. This issue can be addressed by developing a risk model to predict which inpatients might need such a program. We developed such a model for the 391,018 short-term psychiatric hospital admissions of US veterans in Veterans Health Administration (VHA) hospitals 2010-2013. Records were linked with the National Death Index to determine suicide within 12 months of hospital discharge (n=771). The Super Learner ensemble machine learning method was used to predict these suicides for time horizon between 1 week and 12 months after discharge in a 70% training sample. Accuracy was validated in the remaining 30% holdout sample. Predictors included VHA administrative variables and small area geocode data linked to patient home addresses. The models had AUC=.79-.82 for time horizons between 1 week and 6 months and AUC=.74 for 12 months. An analysis of operating characteristics showed that 22.4%-32.2% of patients who died by suicide would have been reached if intensive case management was provided to the 5% of patients with highest predicted suicide risk. Positive predictive value (PPV) at this higher threshold ranged from 1.2% over 12 months to 3.8% per case manager year over 1 week. Focusing on the low end of the risk spectrum, the 40% of patients classified as having lowest risk account for 0%-9.7% of suicides across time horizons. Variable importance analysis shows that 51.1% of model performance is due to psychopathological risk factors accounted, 26.2% to social determinants of health, 14.8% to prior history of suicidal behaviors, and 6.6% to physical disorders. The paper closes with a discussion of next steps in refining the model and prospects for developing a parallel precision treatment model.
| S-EPMC7219514 | biostudies-literature
Project description:Hypertension is increasing in children and warrants disease surveillance. We therefore sought to evaluate the validity of case definitions to identify pediatric hypertension in administrative healthcare data. Cases of hypertension in children 3-18 years of age were identified utilizing blood pressures recorded in the Manitoba Primary Care Research Network (MaPCReN) electronic medical record from 2014 to 2016. Prevalence of hypertension and associated clinical characteristics were determined. We then evaluated the validity of 18 case definitions combining outpatient physician visits (ICD9CM codes), hospital claims (ICD9CM/ICD10 codes) and antihypertensive use within 1-3 years of data housed at the Manitoba Centre for Health Policy. The MaPCReN database identified 241 children with hypertension and 4090 without (prevalence = 5.6%). The sensitivity of algorithms ranged between 0.18 and 0.51 and the specificity between 0.98 and 1.00. Pharmaceutical use increased the sensitivity of algorithms significantly. The algorithms with the highest sensitivity and area under the ROC curve were 1 or more hospitalization OR 1 or more physician claim OR 1 or more pharmaceutical record. Evaluating 2 years of data is recommended. Administrative data alone reflects diagnosis of hypertension with high specificity, but underestimate the true prevalence of this disease. Alternative data sources are therefore required for disease surveillance.
| S-EPMC10175274 | biostudies-literature
Project description:The Paycheck Protection Program (PPP), a principal element of the fiscal stimulus enacted by Congress in response to the COVID-19 economic shock, was intended to assist small businesses to maintain employment and wages during the crisis, as well as cover other expenses. We use high-frequency administrative payroll data from ADP-one of the world's largest payroll processing firms-to estimate the causal effect of the PPP on the evolution of employment at PPP-eligible firms relative to PPP-ineligible firms, where eligibility is determined by industry-specific firm-size cutoffs. Our estimates indicate that the PPP boosted employment at eligible firms by between 2 percent to 5 percent at its peak effect around mid-May 2020. The boost to employment waned thereafter and ranged from no effect to a 3 percent boost at the end of 2020. Our estimates imply that employers retained an additional 3.6 million jobs as of mid-May 2020, and 1.4 million jobs at the end of 2020, as a consequence of PPP. The estimated cost per year of employment retained was $169,000 to $258,000 , equal to 3.4 to 5.2 times median earnings.
| S-EPMC9757653 | biostudies-literature
Project description:Fifty five Armed Forces personnel detected to be seropositives for human immunodeficiency virus were the subjects of the study. After baseline clinical evaluation, laboratory investigations and Centre for Disease Control classification, through a semistructured interview, their sexual orientation, behaviour and psychiatric morbidity were assessed. Sixtynine percent had another sexually transmitted disease as comorbidity. Heterosexual contact was responsible for the infection in 54 out of 55 subjects. Seven patients were freshly diagnosed to have psychiatric illness.
| S-EPMC5529762 | biostudies-other
Project description:This paper presents a novel method for automatically recognizing symptom severity by using natural language processing of psychiatric evaluation records to extract features that are processed by machine learning techniques to assign a severity score to each record evaluated in the 2016 RDoC for Psychiatry Challenge from CEGS/N-GRID. The natural language processing techniques focused on (a) discerning the discourse information expressed in questions and answers; (b) identifying medical concepts that relate to mental disorders; and (c) accounting for the role of negation. The machine learning techniques rely on the assumptions that (1) the severity of a patient's positive valence symptoms exists on a latent continuous spectrum and (2) all the patient's answers and narratives documented in the psychological evaluation records are informed by the patient's latent severity score along this spectrum. These assumptions motivated our two-step machine learning framework for automatically recognizing psychological symptom severity. In the first step, the latent continuous severity score is inferred from each record; in the second step, the severity score is mapped to one of the four discrete severity levels used in the CEGS/N-GRID challenge. We evaluated three methods for inferring the latent severity score associated with each record: (i) pointwise ridge regression; (ii) pairwise comparison-based classification; and (iii) a hybrid approach combining pointwise regression and the pairwise classifier. The second step was implemented using a tree of cascading support vector machine (SVM) classifiers. While the official evaluation results indicate that all three methods are promising, the hybrid approach not only outperformed the pairwise and pointwise methods, but also produced the second highest performance of all submissions to the CEGS/N-GRID challenge with a normalized MAE score of 84.093% (where higher numbers indicate better performance). These evaluation results enabled us to observe that, for this task, considering pairwise information can produce more accurate severity scores than pointwise regression - an approach widely used in other systems for assigning severity scores. Moreover, our analysis indicates that using a cascading SVM tree outperforms traditional SVM classification methods for the purpose of determining discrete severity levels.
| S-EPMC5705296 | biostudies-literature
Project description:IntroductionA significant part of the internal medicine outpatient clinic burden consists of patients who are asymptomatic and intend to have routine check-up tests. In this study, we aimed to investigate the relationship between visit frequency within a year and the undiagnosed anxiety, depressive mood or obsessive-compulsive disorder.MethodsWe included in our study 129 participants who applied for routine check-up tests to our hospital's internal medicine outpatient clinic, without any complaint and known diseases. Individuals were divided into two groups: Group 1 comprised individuals who applied once a year, whereas Group 2 included those who applied more than once a year. Participants underwent routine blood testing, and their mental health was assessed with the Beck`s Depression Inventory (BDI), Beck`s Anxiety Inventory (BAI), and Vancouver Obsessinal Compulsive Inventory (VOCI).Results66% of the 129 participants included in the study were female (n = 85/44, p < 0.001). When laboratory parameters were examined, no significant difference was found except serum vitamin D levels (14.5/19.8 µg/L, p = 0.024, respectively). BDI and BAI scores were statistically significantly higher in Group 2 (10/14, p = 0.032, 11/13.5, p = 0.027, respectively). There was no difference between the two groups in terms of VOCI scores.ConclusionAsymptomatic patients who are visiting clinics for routine checkups constitute a significant part of the outpatient clinic workload. Assessing the mental health of patients who are attending frequently might be helpful in reducing this burden as well as in diagnosing and initiating treatment of undiagnosed underlying mental disorders. To ensure timely referrals of these patients to psychiatry, an adequate referral system and awareness of early signs of anxiety and depression among healthcare professionals are needed.
| S-EPMC11856311 | biostudies-literature
Project description:IntroductionInvoluntary psychiatric hospitalization occurs when someone with a serious mental disorder requires treatment without their consent. Trends vary globally, and currently, there is limited data on involuntary hospitalization in Canada. We examine involuntary hospitalization trends in British Columbia, Canada, and describe the social and clinical characteristics of people ages 15 and older who were involuntarily hospitalized between 2008/2009 and 2017/2018.MethodWe used population-based linked administrative data to examine and compare trends in involuntary and voluntary hospitalizations for mental and substance use disorders. We described patient characteristics (sex/gender, age, health authority, income, urbanity/rurality, and primary diagnosis) and tracked the count of involuntarily hospitalized people over time by diagnosis. Finally, we examined population-based prevalence over time by age and sex/gender.ResultsInvoluntary hospitalizations among British Columbians ages 15 and older rose from 14,195 to 23,531 (65.7%) between 2008/2009 and 2017/2018. Apprehensions involving police increased from 3,502 to 8,009 (128.7%). Meanwhile, voluntary admissions remained relatively stable, with a minimal increase from 17,651 in 2008/2009 to 17,751 in 2017/2018 (0.5%). The most common diagnosis for involuntary patients in 2017/2018 was mood disorders (25.1%), followed by schizophrenia (22.3%), and substance use disorders (18.8%). From 2008/2009 to 2017/2018, the greatest increase was observed for substance use disorders (139%). Over time, population-based prevalence increased most rapidly among women ages 15-24 (162%) and men ages 15-34 (81%) and 85 and older (106%).ConclusionFindings highlight the need to strengthen the voluntary care system for mental health and substance use, especially for younger adults, and people who use substances. They also signal a need for closer examination of the use of involuntary treatment for substance use disorders, as well as further research exploring forces driving police involvement and its implications.
| S-EPMC10037746 | biostudies-literature
Project description:Stress cardiomyopathy or Tako Tsubo cardiomyopathy is a cardiac pathology evoking acute coronary syndrome characterized by electrocardiographic signs, cardiac enzyme elevation and no obstructive coronary lesions. It generally affects postmenopausal women and it usually occurs after periods of intense stress. Disease onset is widely variable, ranging from anginal pain (most common) to cardiogenic shock. Exact pathophysiological mechanism continues to be debated. Various hypotheses have been posited. Abrupt elevation of adrenaline levels appears to be the most credible. In particular, there is no consensus on treatment and prevention. Questions may then be asked about the existence of an underlying psychiatric pathology or a personality predisposition and, therefore, about the role of the psychiatrist in the management of this condition.
| S-EPMC5554664 | biostudies-other
Project description:IntroductionEntrustable professional activities (EPAs) were developed as a way to ensure adequate skills of the medical school graduate. While the 12 EPAs apply to all medical specialties, EPA 1, "Gather a history and perform a physical examination," applies most explicitly to psychiatry through the performance of a mental status exam. Although proficiency in performing a psychiatric interview and mental status exam evolves throughout a psychiatrist's professional life, basic proficiency is essential in order to function as a psychiatry intern. We developed a tool for assessing the mental status exams conducted by future psychiatry residents.MethodsOur tool contains both a video of a psychiatrist interviewing a patient and a mental status exam rating sheet that can be used when students present a mental status exam orally or in writing. We incorporated feedback from psychiatry educators at an annual meeting of the Association for Medical Student Educators in Psychiatry, followed by the reiteration of the video and the rubric. Subsequently, the rubric was verified on the performance of a cohort of 13 third- and fourth-year medical students from three institutions.ResultsIn their mental status exam presentations, students covered all the items measured by the rubric. There was a significant difference between the third- and fourth-year medical students in describing the cognitive exam.DiscussionOverall, our tool offers an opportunity to standardize mental status presentations by senior medical students who wish to specialize in psychiatry.
| S-EPMC6338180 | biostudies-literature
Project description:PurposeTo evaluate the performance of delirium-identification algorithms in administrative claims and drug utilization data.MethodsWe used data from a prospective study of 184 older adults who underwent aortic valve replacement at a single academic medical center to evaluate the following delirium-identification algorithms: (1) International Classification of Diseases (ICD) diagnosis codes for delirium; (2) antipsychotics use; (3) either ICD diagnosis codes or antipsychotics use; and (4) both ICD diagnosis codes and antipsychotics use. These algorithms were evaluated against a validated bedside assessment, the Confusion Assessment Method, and a validated delirium severity scale, the CAM-S.ResultsDelirium occurred in 66 patients (36%), of which 14 (21%) had hyperactive or mixed features and 15 (23%) had severe delirium. ICD diagnosis codes for delirium were present in 15 patients (8%). Antipsychotics were used in 13 patients (7%). ICD diagnosis codes alone and antipsychotics use alone had comparable sensitivity (18% vs. 18%) and specificity (98% vs. 99%). Defining delirium using either ICD diagnosis codes or antipsychotics use, sensitivity improved to 30% with little change in specificity (97%). This algorithm showed higher sensitivity for hyperactive or mixed delirium (64%) and severe delirium (73%). Requiring both ICD diagnosis codes and antipsychotics use resulted in perfect specificity but low sensitivity (6%).ConclusionDelirium-identification algorithms in claims data have low sensitivity and high specificity. Defining delirium using ICD diagnosis codes or antipsychotics use performs better than considering either type of information alone. This information should inform the design and interpretation of claims-based comparative effectiveness and safety research. Copyright © 2017 John Wiley & Sons, Ltd.
| S-EPMC5583076 | biostudies-literature