Russofrom0104

OBJECTIVE Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. DESIGN AND SETTING We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012-2017. SUBJECTS We included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care. METHODS We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients). RESULTS The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11-2.17, P = 0.010; in New Hampshire HR = 2.03, 95% CI = 1.92-2.14, P  less then  0.0001). Similar differences were observed for the acute groups. CONCLUSIONS Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. © 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.OBJECTIVE To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD). DESIGN Quasi-experimental retrospective cohort study. SETTING Ohio Medicaid claims data from August 2011 to August 2016. SUBJECTS Medicaid beneficiaries under age 19 years with SCD. METHODS Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline. RESULTS In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (-2.96 prescriptions per 100 children, P = 0.01) and in the amount of opioids dispensed (-31.39 milligram morphine equivalents per filled prescription, P  less then  0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P  less then  0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P  less then  0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P = 0.63). check details CONCLUSIONS Our results suggest that Ohio's 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse. © 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.OBJECTIVE To improve efficient goal attainment of patients by analyzing the unstructured text in care manager (CM) notes (CMNs). Our task is to determine whether the goal assigned by the CM can be achieved in a timely manner. MATERIALS AND METHODS Our data consists of CM structured and unstructured records from a private firm in Orlando, FL. The CM data is based on phone interactions between the CM and the patient. A portion of the data has been manually annotated to indicate engagement. We present 2 machine learning classifiers an engagement model and a goal attainment model. RESULTS We can successfully distinguish automatically between engagement and lack of engagement. Subsequently, incorporating engagement and features from textual information from the unstructured notes significantly improves goal attainment classification. DISCUSSION Two key challenges in this task were the time-consuming annotation effort for engagement classification and the limited amount of data for the more difficult goal attainment class (specifically, for people who take a long time to achieve their goals). We successfully explore domain adaptation and transfer learning techniques to improve performance on the under-represented classes. We also explore the value of using features from unstructured notes to improve the model and interpretability. CONCLUSIONS Unstructured CMNs can be used to improve accuracy of our classification models for predicting patient self-management goal attainment. This work can be used to help identify patients who may require special attention from CMs to improve engagement in self-management. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.OBJECTIVE Families of youth with Sickle Cell Disease (SCD) can face psychosocial adversity including emotional distress, functional impairments, and sociodemographic risk factors. Systematic screening of psychosocial risk can identify families who may benefit from further assessment and evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief caregiver-report screener based on the tri-level Pediatric Psychosocial Preventative Health Model (PPPHM). METHODS Findings are presented from the baseline assessment of a longitudinal study validating a Sickle Cell version of the PAT 2.0. Primary caregivers of 136 youth with SCD receiving care through a multidisciplinary SCD clinic in a children's hospital completed the PAT and validation measures. A subset of 25 caregivers completed the PAT a second time within 3-5 weeks. RESULTS Internal consistency for the total score was strong (α = .87), and for the subscales was moderate to strong (α  =  .74-.94), with the exception of the Family Structure (α  =  .38), Caregiver Beliefs (α  =  .