Research Objective People with a history of incarceration have high rates of physical and behavioral health conditions as well as increased hospitalizations and emergency department visits. This research extends the existing literature about the health profile of individuals with a history of justice involvement by examining patterns of Medicaid utilization and costs. Study Design We linked New York State Medicaid and New York City Department of Correction Data from 2012–2016 and examined patterns of jail utilization, health care utilization (including inpatient, emergency department, and outpatient use) and health care cost by categories of service, as well as the prevalence of chronic physical and mental health disorders. We selected two sets of comparisons, any jail contact vs. no jail contact and high jail contact vs. low jail contact. Population Studied Individuals with at least one jail admission in 2012 were defined as having any jail contact. Individuals with only one jail admission between 2012–2016 are defined as having low jail contact. Those who were in the top 10 percentile of number of jail admissions are defined as having high jail contact. The no jail contact group is defined as Medicaid recipients matched with individuals with any jail contact on age, sex, race/ethnicity, Medicare status and number of Medicaid enrollment months. Principal Findings Comparing to individuals with no jail contact, any jail contact was associated with a higher prevalence of both chronic physical and mental health conditions; those with any jail contact had a doubling in the risks of mortality and of health care resource use; the average number of hospitalizations was 4 times higher among people with any jail contact; people with jail contact had Medicaid costs that were 3 to 7 times greater, with inpatient costs largely driving these differences for people with the most frequent jail contact. Compared to individuals with low jail contact, individuals with high jail contact had drastically higher prevalence of both chronic physical and mental health conditions, triple the number of hospitalizations, and quadruple the number of emergency department visits. The annual inpatient expenditure of an individual with high jail contact is $12 k higher than that of an individual with low jail contact; total Medicaid expenditures of high contact individuals averages over $33 k per year and are twice as high as those of low contact individuals. Conclusions The prevalence of physical and mental health conditions was very high among individuals with high jail contact, as were their health care costs. Only a small fraction of costs for this group were for outpatient primary care, behavioral health treatment, and case management that could help to address these needs and prevent hospitalization. Implications for Policy or Practice These findings highlight the need for more effective health care engagement strategies for people with a history of incarceration. Specifically, preventative, primary care and behavioral health care services...

Objectives: To describe efficacy/safety of recombinant von Willebrand factor (rVWF) prophylaxis in patients with type 3 von Willebrand disease (VWD).Methods: This post hoc analysis of a phase 3 open-label trial provides a more detailed analysis of adults with type 3 VWD, categorized based on prior treatment at screening: "Prior On-Demand (OD)" (OD VWF; ≥3 documented spontaneous bleeding events [BEs] requiring VWF in previous 12 months) or "Switch" (plasma-derived[pd] VWF prophylaxis for ≥12 months). Annualized bleeding rates (ABRs) were evaluated during 12 months of rVWF prophylaxis versus historical data from medical records.Results: In the Prior OD group (n = 10), mean spontaneous ABR (sABR) for treated BEs was reduced by 91.6% (ratio, 0.08; 95% CI, 0.02-0.45) versus mean historical sABR. In the Switch group (n = 8), mean sABR for treated BEs was reduced by 47% (ratio, 0.53; 95% CI, 0.08-3.62). One non-serious adverse event (AE) was considered

ObjectivesBehavioral health diagnoses are frequently underreported in administrative health data. For a pragmatic trial of a hospital addiction consult program, we sought to determine the sensitivity of Medicaid claims data for identifying patients with opioid use disorder (OUD).MethodsA structured review of electronic health record (EHR) data was conducted to identify patients with OUD in 6 New York City public hospitals. Cases selected for review were adults admitted to medical/surgical inpatient units who received methadone or sublingual buprenorphine in the hospital. For cases with OUD based on EHR review, we searched for the hospitalization in Medicaid claims data and examined International Classification of Diseases, Tenth Revision discharge diagnosis codes to identify opioid diagnoses (OUD, opioid poisoning, or opioid-related adverse events). Sensitivity of Medicaid claims data for capturing OUD hospitalizations was calculated using EHR review findings as the reference standard measure.ResultsAmong 552 cases with OUD based on EHR review, 465 (84.2%) were found in the Medicaid claims data, of which 418 (89.9%) had an opioid discharge diagnosis. Opioid diagnoses were the primary diagnosis in 49 cases (11.7%), whereas in the remainder, they were secondary diagnoses.ConclusionIn this sample of hospitalized patients receiving OUD medications, Medicaid claims seem to have good sensitivity for capturing opioid diagnoses. Although the sensitivity of claims data may vary, it can potentially be a valuable source of information about OUD patients.