Kevin C Heslin

Special Services for Women in Substance Use Disorders Treatment: How Does the Department of Veterans Affairs Compare with Other Providers?

BACKGROUND Gender is an important consideration in the treatment of substance use disorders (SUD). Although the number of women seeking care through the Department of Veterans Affairs (VA) has increased dramatically, little is known about the capacity of the VA to meet the needs of women with SUD. We examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 SUD treatment facilities. METHODS Using data from the 2012 National Survey of Substance Abuse Treatment Services, we calculated the percent of VA facilities offering special programs or groups exclusively for women, compared with facilities under other types of ownership. For each ownership type, we also calculated the mean number of ancillary services offered that are critical for many women in SUD treatment, including child care, domestic violence counseling, and transportation assistance. Multivariable models were used to adjust for differences in other facility characteristics. FINDINGS Approximately 31% of facilities had special programs exclusively for women. The VA had the lowest prevalence of programs for women, at 19.1%; however, the VA offered an average of 5 key services for women, which was significantly higher than the averages for other federal (n = 2), local (n = 4), and private for-profit (n = 2) facilities. Results were generally robust to multivariable adjustments. CONCLUSIONS The VA should consider developing more SUD programs and groups exclusively for women, while maintaining ancillary services at their relatively abundant level. Gender-specific programs and groups could serve as points of referral to ancillary services for women veterans.

A qualitative investigation that applies an ecological strengths-based perspective to veterans' experience of reintegration into civilian life

ABSTRACT Reintegration to civilian life continues to be challenging for many veterans despite numerous programs that were developed to assist with this process. Emerging literature suggests veteran engagement in volunteer organizations promotes their reintegration. Our exploratory study applies an ecological strengths-based framework to enhance our knowledge of veteran volunteerism and reintegration in the context of a disaster relief organization: Team Rubicon. Findings suggest ecological factors, such as re-creating a familiar culture of camaraderie among veterans and building upon individual strengths that allow veterans to apply their specialized skills, helped instill feelings of connectedness and contribution to their respective civilian communities.

Shifts in Alcohol-Related Diagnoses After the Introduction of International Classification of Diseases, Tenth Revision, Clinical Modification Coding in U.S. Hospitals: Implications for Epidemiologic Research

BACKGROUND In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. METHODS This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods. RESULTS On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder. CONCLUSIONS Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the ICD-10-CM transition is to aggregate diagnosis codes into broader, clinically meaningful groups-including a single global group that encompasses all alcohol-related stays-and then to select diagnostic groupings that minimize discontinuities between the 2 coding systems while providing useful information on this important indicator of population health.

“We Are Disaster Response Experts”: A Qualitative Study on the Mental Health Impact of Volunteering in Disaster Settings Among Combat Veterans

ABSTRACT Volunteers serving in a disaster context may experience harmful mental health effects that could impede rescue operations. Exploratory research suggests that combat veterans who volunteer in Team Rubicon (TR)—a disaster relief social service organization with the mission of uniting the skills and experiences of military Veterans with first responders to rapidly deploy emergency response teams—have positive mental health responses when providing disaster relief. The objective of this qualitative study was to identify those nuances associated with combat veterans’ mental health response in TR. The study consisted of (N = 9) male combat Veterans who volunteered with TR. Data was thematically analyzed. Results suggested that members did not experience negative mental health effects because of prior military training and preparedness relevant to disaster situations. Positive outcomes in mental health were associated with the uniqueness of peer support in TR and applying skills from military training. Veterans in TR reported that providing disaster relief afforded them the opportunity to continue serving others after having served in the military. Implications for public health social work are discussed as well as the need for further research.

Identifying inpatient costs attributable to the clinical sequelae and comorbidities of alcoholic liver disease in a national hospital database

Background and Aims The clinical sequelae and comorbidities of alcoholic liver disease (ALD) often require hospitalization. The aims of this study were to (1) compare the average costs of hospitalizations with ALD and the costs of hospitalizations with other alcohol‐related diagnoses that do not involve the liver; and (2) estimate the percentage of the difference in costs between the ALD and non‐ALD hospitalizations that may be attributed to ascites, protein–calorie malnutrition and other conditions. Design The 2012 National Inpatient Sample is a population‐based cross‐sectional database representing more than 94% of all discharges from community hospitals in the United States. Setting Community hospitals in the United States. Participants The sample included 72 531 hospitalizations with ALD and 287 047 hospitalizations with other alcohol‐related diagnoses. Measurements The dependent variable was total in‐patient costs. We estimated the contribution of ascites, protein–calorie malnutrition and other conditions to the difference in costs between patients with ALD and patients with other diagnoses. Findings Average costs for ALD patients were

Admissions after discharge from an emergency department for chest symptoms

3188.4 higher than those for patients with other diagnoses (

The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study

13 543 versus

Age-related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

10 355; P < 0.001). Among all conditions in the analysis, protein–calorie malnutrition had the largest impact on costs [

HIV Hospital Stays in the United States, 2006–2013

6501; 95% confidence interval (CI) = 5956, 7045; P < 0.001] accounting for 12% of the higher costs of ALD stays. Conclusions Costs of hospital care for patients with alcoholic liver disease are higher than those for patients with other alcohol‐related diagnoses. These increased costs are associated with specific clinical sequelae and comorbidities, with protein–calorie malnutrition—a largely preventable condition—making a substantial contribution.

Mental and Substance Use Disorders Among Hospitalized Teenagers, 2012

Abstract Background: Often patients who present to the emergency department (ED) with chest symptoms return to the hospital within 30 days with the same or closely related symptoms and are admitted, raising questions about quality of care, timeliness of diagnosis, and patient safety. This study examined the frequency of and patient characteristics associated with subsequent inpatient admissions for related symptoms after discharge from an ED for chest symptoms. Methods: We used data from the 2012 and 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) from eight states to identify over 1.8 million ED discharges for chest symptoms. Results: Approximately 3% of ED discharges experienced potentially related subsequent admissions within 30 days – 0.2% for acute myocardial infarction (AMI), 1.7% for other cardiovascular conditions, 0.5% for respiratory conditions, and 0.6% for mental disorders. Logistic regression results showed higher odds of subsequent admission for older patients and those residing in low-income areas, and lower odds for females and non White racial/ethnic groups. Privately insured patients had lower odds of subsequent admission than did those who were uninsured or covered by other programs. Conclusions: Because we included multiple diagnostic categories of subsequent admissions, our results show a more complete picture of patients presenting to the ED with chest symptoms compared with previous studies. In particular, we show a lower rate of subsequent admission for AMI versus other diagnoses. ED physicians and administrators can use the results to identify characteristics associated with increased odds of subsequent admission to target at-risk populations.