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ALZHEIMER’S: Update on the latest research

This is a 40-minute audio interview with two leading Alzheimer’s researchers, Dr. Rudolph Tanzi (Harvard) and Dr. Berislav Zlokovic (University of Southern California).  They are discussing the latest thinking and direction of research into dementia.  This discussion is intended for clinicians.

Alzheimer’s patients tend to have the disease for a long time – as long as 10 to 15 years – before symptoms occur.  One avenue of research is how to identify patients at a younger age, when they are asymptomatic.

There is an important connection between the overall health of the vascular system and staving off the accumulation of amyloid β-proteins into plaque in the brain.  The brain has some 400 miles of blood vessels and is good at quickly creating new blood vessels as needed.  Exercise prompts this.  Researchers are investigating ways to keep amyloid β – which has the function of fighting pathogens – from clumping up and failing to be cleared from the brain when their role is done and then killing neurons.  There is also investigation into what the pathogens are that are triggering the amyloid in the first place – and whether there might be possibility of a vaccine.

Source: Alzheimer outlook far from bleak. (2017, February 15). JAMA.  Click here for free access: http://jamanetwork.com/learning/audio-player/14072698  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY DEPARTMENT: What is a warm handoff?

Reading Hospital (West Reading, PA) implemented a program in early 2016 referred to as a “warm handoff” intended to help patients who present in the emergency department with heroin or other opioid addiction.  The idea is to first care for whatever caused the patient to come to the ED and then connect the patient with a substance abuse treatment program.  If the patient is interested in accepting the warm handoff, the ED staff makes a connection to appropriate mental health staff.

The hospital website indicates that the Reading Hospital is one of the busiest EDs in Pennsylvania, with over 107,000 ED visits per year.  The warm handoff program is currently operating at about one patient every two days … so 182 warm handoff patients per year, by my calculation.  Or, 182 patients/107,000 visits = 170 warm handoff patients/100,000 ED visits, again by my calculation.

Sources:

Sandel, K. (2016, May 18). What is the ‘warm hand-off’ and how can it help Pennsylvania’s opioid abuse crisis? Pennsylvania Medical Society Quality and Value Blog. https://www.pamedsoc.org/tools-you-can-use/topics/quality-and-value-blog/BlogMay1816

Warm handoffs connect substance abuse patients to vital services. (2016, Oct.). ED Management, 28(10), 118-119. Click here for publisher website: https://www.ahcmedia.com/articles/138640  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Core Competencies for Behavioral Health Providers Working in Primary Care

Eight core competencies for licensed behavioral health providers working in primary care have been defined by a Colorado consensus group. Each of the following competencies are further expanded, and examples are provided:

  1. Identify and assess behavioral health needs as part of a primary care team
  2. Engage and activate patients in their care
  3. Work as a primary care team member to create and implement care plans that address behavioral health issues
  4. Help observe and improve care team function and relationships
  5. Communicate effectively with other providers, staff, and patients
  6. Provide efficient and effective care delivery that meets the needs of the population of the primary care setting
  7. Provide culturally responsive, whole-person and family-oriented care
  8. Understand, value, and adapt to the diverse professional cultures of an integrated care team

Source: Miller BF and others. Core competencies for behavioral health providers working in primary care. Prepared for Colorado Consensus Conference, Feb. 2016. Organized by Eugene S. Farley Jr. Health Policy Center, University of Colorado School of Medicine. http://www.umassmed.edu/globalassets/center-for-integrated-primary-care/non-images-links-etc/resources/core-competencies-for-behavioral-health-providers-working-in-primary-care.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospitalizations Involving Mental and Substance Use Disorders Among Adults

According to a recent report from the Agency for Healthcare Research and Quality, 8.6 million hospitalizations involved at least one mental or substance abuse disorder in 2012, accounting for nearly a third of all inpatient stays. However, mental/substance abuse discorders were the primary reason for 1.8 million or 6.7% of all inpatient stays.

Mood disorders were the most common primary diagnosis for mental disorders, while alcohol-related disorders were the most frequent substance abuse diagnosis. Nearly 14% of those with a primary mental or substance abuse diagnosis were uninsured. Medicare and Medicaid covered 56% of all primary mental/substance abuse hospitalizations.

Source: Heslin KC and others. Hospitalizations involving mental and substance use disorders among adults, 2012. HCUP [Healthcare Cost and Utilization Project] Statistical Brief, no. 191, June 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb191-Hospitalization-Mental-Substance-Use-Disorders-2012.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Health Policy Brief: Enforcing Mental Health Parity

There have been legislative and regulatory efforts over the years to bring mental health treatment and coverage to an equal level as that for other health issues.

Most recently, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, and the Affordable Care Act specified mental health and substance abuse treatment as an essential health benefit for Marketplace health plans. Earlier this year, the Centers for Medicare and Medicaid Services released proposed regulations for implementing the MHPAEQ.

This updated policy briefing looks at the issue of mental health parity, its background, current law, the debate, and what’s next. It addresses access; equivalence, quality and efficacy of services; Medicaid; and has a new focus on enforcement.

Source: Goodell S. Health Policy Brief: Enforcing mental health parity. HealthAffairs.org, Nov. 9. 2015. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_147.pdf

Related: National Alliance on Mental Illness, A long road ahead: achieving true parity in mental health and substance use care.  April 2015.  http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Common Mistakes in Designing Psychiatric Hospitals

The Facility Guidelines Institute [FGI] recently published a white paper on common mistakes made when designing psychiatric hospitals. While the report points out there is no one-size fits all solution, it discusses common design errors  from the perspectives of a therapeutic environment, patient and staff safety concerns, programming, general layout, and general level of precautions.

The authors of the report have also written Design Guide for the Built Environment of Behavioral Health Facilities, formerly published by the National Association of Psychiatric Health Systems, but now being published by FGI.

FGI coordinates the ongoing consensus process for updating and revising the Guidelines for the Design and Construction of Healthcare Facilities, used by “The Joint Commission, many federal agencies, and authorities in 42 states … either as a code or a reference standard when reviewing, approving, and financing plans; surveying, licensing, certifying, or accrediting newly constructed facilities; or developing their own codes.

Source: Hunt J. and Sine DM. Common mistakes in designing psychiatric hospitals: an update. Facility Guidelines Institute, May 2015. http://fgiguidelines.org/pdfs/FGI_CommonMistakesPsychiatricHospitals_1505.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospital Readmissions for Psychiatric Conditions

The Agency for Healthcare Research and Quality has released two new reports focused on psychiatric readmissions.

The first is a statistical brief looking at readmission rates for psychiatric conditions. It indicates the 30-day readmission rate for schizophrenia in 2012 was 15.7%, while it was 9% for primary diagnoses involving mood disorders. This compares to a 3.8% readmission rate for all other non-mental health/substance abuse conditions.

The second report comes from AHRQ’s Effective Health Care Program. It identifies and evaluates the research on strategies to reduce hospital readmissions for psychiatric conditions. It found availability and implementation of strategies varied widely and concluded more research is needed to determine which are most effective, especially in settings with varying resources.

Psychiatric readmissions are probably undercounted, according to the report. More research on ways to accurately measure the most meaningful outcomes for psychiatric conditions is also needed.

In 2012, nearly one quarter of U.S. adults experienced some form of mental or substance abuse disorder.

Sources:

Heslin KC and Weiss AJ. Hospital readmissions involving psychiatric disorders, 2012. HCUP (Healthcare Cost and Utilization Project) Statistical Brief, no. 189, May 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb189-Hospital-Readmissions-Psychiatric-Disorders-2012.pdf

Gaynes BN and others. Management strategies to reduce psychiatric readmissions. Effective Health Care Program Technical Brief no. 21,  May 21, 2015. http://www.effectivehealthcare.ahrq.gov/ehc/products/596/2082/psychiatric-readmissions-report-150521.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org