Objective This study evaluates the impact of an integrated Behavioral Health Home (BHH) pilot for adults with psychotic and bipolar disorders. Methods Quasi-experimental methods were used to compare outcomes pre- (September 2014 to August 2015) and post-intervention (September 2015 to August 2016) among ambulatory BHH participants and non-participants. Electronic health records of 424 BHH participants (369 with a psychotic disorder; 55 with bipolar disorder) were compared with 1521 individuals not in the BHH from an urban, safety-net health system. Groups were propensity score-weighted by sex, age, race/ethnicity, language, 2010 Census block group demographics, Medicare and Medicaid enrollment, and diabetes diagnosis. Results BHH participants had fewer total psychiatric inpatient (IP) visits and fewer total ED visits compared to non-BHH patients, which was predominantly driven by the smaller number of visits among BHH participants with ≥1 visit. There were no differences in medical hospitalizations. While BHH participants were more likely to receive HbA1c screening, there were no differences in lipid monitoring. Regarding secondary outcomes, there were no significant differences in changes in metabolic monitoring parameters among patients with diabetes. Conclusions Participation in a pilot ambulatory BHH program was associated with significant reductions in ED visits and psychiatric hospitalizations, and increased HbA1c monitoring, among patients with psychotic and bipolar disorders. Longer-term evaluation is needed to assess impact on care processes and population health outcomes. This evaluation builds on prior research by specifying intervention details and the clinical target population, strengthening the evidence base for care integration to support further program dissemination.

Summary Laryngoscopy .The inspection of previous anaesthetic records is an important part of pre-anaesthetic assessment. The appearance of laryngeal structures at previous direct laryngoscopy, as well as information about tracheal intubation, is particularly helpful, not least because prediction of ease of intubation from the pre-operative physical examination can be unreliable. Although many anaesthetists use the numerical grading system of Cormack and Lehane [l] to record appearances at direct laryngoscopy, it became apparent to the authors that there might be uncertainty about it, which may be of clinical importance. The following survey was carried out to assess the prevalence of usage of this numerical grading system by practising anaesthetists and to assess their knowledge of the system. allowed to alter earlier answers using information gained from subsequent questions, except if they had obviously misinterpreted a previous question.For question 4(a), the interviewees were shown a diagram of the appearances at a 'normal' laryngoscopy, with a good view of all laryngeal structures (Fig. 1). The vocal cords, arytenoid cartilages and epiglottis were specifically pointed out to familiarise interviewees with the Methodr One hundred and twenty anaesthetists from three regional health authorities were interviewed directly by the authors, using the questionnaire shown ( Table 1). Forty anaesthetists were interviewed in each region, of whom 10 were from each grade (senior house officer, registrar, senior registrar and consultant). Anaesthetists were selected for interview only if their preferences regarding recording of laryngoscopic appearances were unknown to the interviewer.The questions were simultaneously shown to and read out to the interviewee and the response recorded. Questions were asked in the order shown and interviewees were not

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Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.