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Hunter S.B.,RAND Health | Schwartz R.P.,Friends Research Institute | Friedmann P.D.,Baystate Health
Journal of Substance Abuse Treatment | Year: 2016

National efforts are underway to integrate medical care and behavioral health treatment. This special issue of the Journal of Substance Abuse Treatment presents 13 papers that examine the integration of substance use interventions and medical care. In this introduction, the guest editors first describe the need to examine the integration of substance use treatment into medical care settings. Next, an overview of the emerging field of implementation science and its applicability to substance use intervention integration is presented. Preview summaries of each of the articles included in this special issue are given. Articles include empirical studies of various integration models, study protocol papers that describe currently funded implementation research, and one review/commentary piece that discusses federal research priorities, integration support activities and remaining research gaps. These articles provide important information about how to guide future health system integration efforts to treat the millions of medical patients with substance use problems. © 2015 Elsevier Inc.

Artenstein A.W.,Baystate Health
In the Blink of an Eye: The Deadly Story of Epidemic Meningitis | Year: 2013

This book is an account of a major historical event, in the world of medicine. As the son of one of the lead scientists who developed the vaccine for meningococcal meningitis, Andrew Artenstein has a unique perspective on the story. In the Blink of an Eye shares his experience. © Springer Science+Business Media New York 2013. All rights are reserved.

Culler S.D.,Emory University | Kugelmass A.D.,Baystate Health | Brown P.P.,HealthTrust Purchasing Group L.P. | Reynolds M.R.,Lahey Hospital and Medical Center | Simon A.W.,HealthTrust Purchasing Group L.P.
Circulation | Year: 2015

Background-This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012. Methods and Results-This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes (inpatient setting) and Current Procedural Terminology and Ambulatory Payment Classification codes (nonadmission) were used to identify revascularizations. The study population consists of 2 768 007 records. This study finds that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60 405-106 495) has been more than offset by the decrease in PCI admissions (363 384-295 434) during the study period. There also were >18 000 fewer coronary artery bypass graft admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any coronary artery bypass graft surgery and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCIs; and 19 (1.6%) more sites were performing coronary artery bypass graft surgery. Conclusions-The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and declined by >4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period. © 2014 American Heart Association, Inc.

Mularski R.A.,Kaiser Permanente | McBurnie M.A.,Kaiser Permanente | Lindenauer P.K.,Baystate Health | Lee T.A.,University of Illinois at Chicago | And 4 more authors.
Journal of Comparative Effectiveness Research | Year: 2012

Chronic obstructive pulmonary disease affects millions worldwide. It is Americas third leading cause of death, and results in significant morbidity and cost. Although many therapies exist and are being developed to alleviate symptoms and decrease morbidity and mortality in chronic obstructive pulmonary disease, most have only been studied in placebo-controlled efficacy studies in highly selected populations. Comparative effectiveness and translational research in chronic obstructive pulmonary disease will require the development of infrastructures to support collaboration between researchers and the stakeholders who generate, disseminate and use new knowledge. Methodologies need to evolve to both prioritize research questions and to conduct collaborative comparative effectiveness research studies. Given the impracticality of testing every clinical intervention in comparative pragmatic trials for comparative effectiveness research in chronic obstructive pulmonary disease, we advocate expanding methodology that includes the use of observational databases with serially performed effectiveness analyses and quasi-experimental designs that include following healthcare changes longitudinally over time to assess benefit, harm, subgroups and cost. © 2012 Future Medicine Ltd.

Liptzin B.,Baystate Health | Peisah C.,University of New South Wales | Shulman K.,University of Toronto | Finkel S.,University of Chicago
International Psychogeriatrics | Year: 2010

Background: With the aging of the population there will be a substantial transfer of wealth in the next 25 years. The presence of delirium can complicate the evaluation of an older person's testamentary capacity and susceptibility to undue influence but has not been well examined in the existing literature. Methods: A subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to review how to assess prospectively and retrospectively testamentary capacity and susceptibility to undue influence in patients with delirium. Results: The subcommittee identified questions that should be asked in cases where someone changes their will or estate plan towards the end of their life in the presence of delirium. These questions include: was there consistency in the patient's wishes over time? Were these wishes expressed during a lucid interval when the person was less confused? Were the patient's wishes clearly expressed in response to open-ended questions? Is there clear documentation of the patient's mental status at the time of the discussion? Conclusions: This review with some case examples provides guidance on how to consider the question of testamentary capacity or susceptibility to undue influence in someone undergoing an episode of delirium. Copyright © 2010 International Psychogeriatric Association.

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