IntroductionThe prevalence of chronic physical and mental disorders is increasing among children and adolescents in the United States. In this study, we investigated the association between mental health disorders and chronic physical conditions among children, and we assessed whether having mental disorders is associated with increased health care costs for children with chronic physical conditions, using Medical Expenditure Panel Survey data from 2008 through 2013.MethodsChildren aged 5 to 17 with at least 1 chronic physical condition were included in the study. Chronic physical conditions and mental disorders were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. We used logistic regression to assess the relationship between mental disorders and chronic physical conditions, and we used generalized linear models with gamma distribution and log link to estimate direct medical costs.ResultsOf 42,130 children, 4,640 had at least 1 chronic physical condition. After controlling for sociodemographic and health care access characteristics, we found that children with at least 1 chronic physical condition were 62% more likely to have a mental health disorder than were children without chronic physical conditions (odds ratio = 1.62; 95% confidence interval [CI], 1.37–1.92). Having a mental disorder was a significant predictor of total health care cost (β = 0.64; 95% CI, 0.43–0.85; P < .001). The adjusted annual incremental cost due to mental disorders among children with chronic physical conditions was $2,631 (P < .001).ConclusionHaving chronic physical conditions in childhood is a significant predictor of mental health disorders and total health care expenditures.

ObjectiveTo examine age, gender, and temporal differences in baseline characteristics and clinical outcomes of adult patients hospitalised with COVID-19.DesignA cohort study using deidentified electronic medical records from a Global Research Network.Setting/Participants67 456 adult patients hospitalised with COVID-19 from the USA; 7306 from Europe, Latin America and Asia-Pacific between February 2020 and January 2021.ResultsIn the US cohort, compared with patients 18–34 years old, patients ≥65 had a greater risk of intensive care unit (ICU) admission (adjusted HR (aHR) 1.73, 95% CI 1.58 to 1.90), acute respiratory distress syndrome(ARDS)/respiratory failure (aHR 1.86, 95% CI 1.76 to 1.96), invasive mechanical ventilation (IMV, aHR 1.93, 95% CI, 1.73 to 2.15), and all-cause mortality (aHR 5.6, 95% CI 4.36 to 7.18). Men appeared to be at a greater risk for ICU admission (aHR 1.34, 95% CI 1.29 to 1.39), ARDS/respiratory failure (aHR 1.24, 95% CI1.21 to 1.27), IMV (aHR 1.38, 95% CI 1.32 to 1.45), and all-cause mortality (aHR 1.16, 95% CI 1.08 to 1.24) compared with women. Moreover, we observed a greater risk of adverse outcomes during the early pandemic (ie, February–April 2020) compared with later periods. In the ex-US cohort, the age and gender trends were similar; for the temporal trend, the highest proportion of patients with all-cause mortality were also in February–April 2020; however, the highest percentages of patients with IMV and ARDS/respiratory failure were in August–October 2020 followed by February–April 2020.ConclusionsThis study provided valuable information on the temporal trends of characteristics and outcomes of hospitalised adult COVID-19 patients in both USA and ex-USA. It also described the population at a potentially greater risk for worse clinical outcomes by identifying the age and gender differences. Together, the information could inform the prevention and treatment strategies of COVID-19. Furthermore, it can be used to raise public awareness of COVID-19’s impact on vulnerable populations.

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Objectives: Pharmacist interventions may prevent adverse events after hospital discharge and reduce the risk of readmission as well as healthcare costs. This study evaluates the impact of pharmacist-provided post-discharge services on healthcare utilization and cost for members of a US managed Medicaid health plan. MethOds: Synergy Pharmacy Solutions (SPS) provides ambulatory care pharmacy-based transitional care services for high risk hospital discharges covered by Kern Health Systems (KHS) managed Medicaid plan. Over 1,100 qualifying discharged patients from Bakersfield Memorial Hospital were referred to SPS. A control group of matched KHS discharges from neighboring hospitals were then identified by matching each to a hospitalization episode in the experimental group based on the number of prior hospitalizations and length of stay [±1 day]. Experimental patients could have more than one matched control hospitalization. Thirty-day and 180-day readmission rates were analyzed using logistic regression and Cox proportional hazards models. Thirty-day and 180-day inpatient, outpatient, prescription drug, emergency room, and total costs were analyzed by OLS and GLM regressions. Demographics, clinical characteristics, and comorbidity profiles were used as independent variables in all models. Results: We found a 28.0% reduction in 30-day readmissions [OR= 0.720 (95% CI 0.526 to 0.985)] and a 31.9% reduction in 180-day readmissions [OR= 0.681 (95% CI 0.507 to 0.914]. Cox model on time to readmission estimated the overall hazard ratio of readmission at 0.

Regular screening is considered the most effective method to reduce the mortality and morbidity associated with breast cancer. Nevertheless, contradictory evidence about screening mammograms has led to periodic changes and considerable variations among different screening guidelines. This study is the first to examine the immediate impact of the 2009 US Preventive Services Task Force (USPSTF) guideline modification on physician recommendation of mammograms. The study included visits by women aged 40 years and older without prior breast cancer from the National Ambulatory and Medical Care Survey 2008-2010. Bivariate and multiple logistic regressions were used to determine the factors associated with mammography recommendation. Approximately 29,395 visits were included and mammography was recommended during 1350 visits; 50-64-year-old women had 72% higher odds, and 65-74-year-old women had twice the odds of getting a mammogram recommendation compared with 40-49-year-old women in 2009. However, there was no difference in recommendation by age groups in 2008 and 2010. Obstetricians and gynecologists did not modify their recommendation behavior in 2009, unlike all other specialists who reduced their recommendation for 40-49-year-old women in 2009. Other characteristics associated with mammogram recommendations were certain patient comorbidities, physician specialty and primary care physician status, health maintenance organization status of the clinic, and certain visit characteristics. This study demonstrated a temporary effect of the USPSTF screening guideline change on mammogram recommendation. However, in light of conflicting recommendations by different guidelines, the physicians erred toward the more rigorous guidelines and did not permanently reduce their mammogram recommendation for women aged 40-49 years.