Mother and child with doctor

Influences of health and environmental deprivation on family relationships among children with chronic disease

Influences of health and environmental deprivation on family relationships among children with chronic disease

Families are often the primary source of close, comforting relationships for children and adolescents. Among chronically ill children, families play a critical role in managing aspects of the disease, often on a daily basis.

In this publication, authors including HIP Investigator, Dr. Elizabeth Cox used the Patient-Reported Outcomes Measurement Information System (PROMIS) Family Relationships measure over time to understand how family relationships are influenced by these three factors—the characteristics of the child and parent, environmental deprivation, and health over time, among children 8–17 years of age with one of three chronic illnesses (asthma, type 1 diabetes [diabetes], and sickle cell disease).

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Little girl sleeping hospital bed

Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

Patient-reported outcome (PRO) measures quantify patient health and health-related experiences directly from the patient perspective, which is important for patient-centered care. PROs can be used to monitor trends in patients’ symptoms, function, or well-being; to inform decision-making; and to prompt additional patient education or referrals. Use of PRO scores in clinical practice has improved recall of patient concerns by clinicians, increased shared decision-making, and enhanced care processes and treatment planning.

The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) provides standardized PRO measures for use in clinical practice, with specific measures available for adults, children from 8 to 17 years of age, and parent proxies for children 5-17 years old. In this publication, HIP Investigator Dr. Elizabeth Cox et al. sought to find the benefits of using PROMIS measures in pediatric clinical settings, health system and clinician leaders must attend to how the measures are implemented and used, as well as the support required to achieve this goal.

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Increasing Medicaid enrollment among formerly incarcerated adults

Increasing Medicaid enrollment among formerly incarcerated adults

Formerly incarcerated adults bear a disproportionate burden of disease, including substance use disorders, mental illness, and HIV, conditions that require timely and ongoing medical care. However, as they reenter the community from correctional facilities, the likelihood of receiving treatment for many chronic conditions declines relative to the incarceration period, and they experience high rates of emergency department use, substance use, and elevated rates of mortality particularly due to drug overdose.

Improved access to health care in the reentry period has the potential to mitigate these relatively high rates of morbidity and mortality. However, historically a key component of access, health insurance coverage, has been largely unavailable to this population. In this publication, HIP Investigator, Dr. Marguerite Burns et al. aimed to estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.

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WMJ: Impact of Race and Racism on Health

Identifying Substantial Racial and Ethnic Disparities in Health Outcomes and Care in Wisconsin Using Electronic Health Record Data

Identifying Substantial Racial and Ethnic Disparities in Health Outcomes and Care in Wisconsin Using Electronic Health Record Data

Although Wisconsin ranks highly in overall health care quality, the state performs poorly with respect to health disparities. To eliminate health disparities in Wisconsin, it is critical to understand where disparities exist.

Measuring disparities in health outcomes and care allows for benchmarking of current performance and monitoring changes over time. Measurement also allows stakeholders to prioritize efforts and develop and implement programs for the populations that are most impacted by disparities. Authors including HIP Investigator, Dr. Maureen Smith identified racial and ethnic disparities in health outcome and care measures in Wisconsin.

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View the Wisconsin Health Disparities Reports

View Wisconsin Health Disparities Report Appendices

Elderly patient with nurse

Management of Fecal Incontinence

Management of Fecal Incontinence

Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Nine percent of adult women experience episodes of fecal incontinence at least monthly. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low.

HIP Investigator, Dr. Heidi Brown et al. provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician–gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons.

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Implementing parity for mental health and substance use treatment in Medicaid

Implementing parity for mental health and substance use treatment in Medicaid

Rates of mental health and substance use disorders (MHSUDs) in the adult Medicaid population are higher than for adults with Medicare or private health insurance. In this publication, HIP Investigator, Dr. Marguerite Burns et al. estimates the association between the implementation of parity in coverage for mental health and substance use disorder (MHSUD) services within the Medicaid program and MHSUD service use.

The author’s findings suggest that parity implementation in Medicaid could increase access to effective MHSUD services in a high‐need population.

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The Balanced Opioid Initiative

The Balanced Opioid Initiative

Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. The challenge remains in implementing guidelines in a way that balances safety and effectiveness when following clinical guidelines recommending opioid prescribing practices.

HIP Investigator, Dr. Andy Quanbeck et al. designed a study to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. The results of the study promise to help understand how to cost effectively improve the implementation of evidence-based practices.

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Doctor consulting woman

Stumbling Into Adulthood: Learning From Depression While Growing Up

Stumbling Into Adulthood: Learning From Depression While Growing Up

In the United States, approximately 16% of adults aged 18 to 24 years report having been diagnosed with depression at some point in their lives. Growing attention to the specific impact of depression on people in their late teens and twenties corresponds with efforts in the behavioral and social sciences to more carefully delineate “emerging adulthood” either as a distinctive developmental phase, or simply as a protracted period between adolescence and adulthood created by contemporary social and economic conditions.

In this article, HIP Investigator Dr. Rachel Grob et al. examine how depression impacted respondent's transition from adolescence to emerging adulthood, and built their capacity to form a coherent identity and find a purpose in life.

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Doctor talking to young patient

Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

As of September 2019, 5 states have received federal waivers to temporarily suspend Medicaid eligibility for individuals who fail to pay required premiums. These periods, ranging from 3 to 12 months, are called lockouts, noneligibility periods, or restrictive reenrollment periods. Wisconsin received a Section 1115 waiver allowing the application of premiums enforced by lockouts among adults receiving transitional medical assistance (TMA), a federally required Medicaid category that provides time-limited coverage to parents and/or caretakers when their incomes increase to exceed the Medicaid program maximum. Wisconsin did not expand Medicaid under the Patient Protection and Affordable Care Act; TMA covers some individuals who would otherwise be eligible for the expansion.

A team of authors including HIP Investigator, Dr. Marguerite Burns conducted a survey study comparing the demographic characteristics, access to care, and health status of recent Medicaid enrollees in Wisconsin with and without experience of Medicaid lockouts.

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Holding hands

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work, Dr. Jared Huling and HIP Investigators Dr. Menggang Yu and Dr. Maureen Smith introduced a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time.

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