Jim Banta

Empirical evidence demonstrates the comorbidity of asthma and mental illness, though limited studies have evaluated the patient and hospital outcomes associated with such conditions. As such, this study evaluated the burden of this comorbidity on health resource utilization and patient disposition among asthma hospitalizations. A secondary analysis of the Nationwide Inpatient Sample (2009-2011) was conducted, with study population of asthma hospitalizations limited to those 18 years of age and older. ICD-9-CM codes were utilized to identify asthma and mental illness discharges. Length of stay was defined as number of days stayed in the hospital, total charges were inflation-adjusted, and patient disposition was defined as routine versus not routine. All analyses were survey-weighted and adjusted for patient and hospital characteristics. Approximately 29% of the asthma hospitalizations reported mental illness. Any mental illness was associated with increased length of stay in the hos...

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

ABSTRACT Background. Studies of medical care among diabetics with serious mental illness (SMI) have produced equivocal results, some show adequate and others show suboptimal treatment. This study examines the relationship of SMI to diabetes care among adults using a large survey, adjusting for sociodemographics, insurance, income, and physical health status. Methods. The California Health Interview Survey, conducted biannually by UCLA since 2001, is a population-based, random digit dial telephone household survey. The 43,020 completed surveys obtained in 2005 are representative of 26.4 million adults. SMI was defined by a Kessler 6 scale score greater than or equal to 13. Stata S/E 9.2 was used for survey-adjusted multi-variable logistic regression analyses. Results. Physicians had told 3,348 survey respondents (representing 1.8 million California adults) that they had diabetes. A total of 7.3% of diabetes patients had Kessler 6 scores above the SMI criterion. SMI predicted diabetes control medication nonadherence (OR = 0.57, 95% CI= 0.38 - 0.85); moreover SMI predicted lower likelihood of physicians checking their patients' feet for sores within the last year (OR = 0.50, 95% CI = 0.30 0.83). On the other hand, SMI was not significantly associated with physicians dilating patients' eyes for exams in the last 2 years or checking hemoglobin A or C levels in the last year. Conclusions. SMI is associated with medication nonadherence and one aspect of suboptimal care. Those clinically responsible for the care of diabetic patients with SMI must understand patients' limits as well as other factors that may underlie less comprehensive care.

BACKGROUND: There are a limited number of population-based studies of mental health treatment among children. OBJECTIVE: To conduct an epidemiological study of factors associated with children's receipt of mental health services in the prior year (yes/no), using the largest state-level survey in the United States. METHOD: A Behavioral Model approach examining a number of predisposing, enabling, and need measures was used with 2007 Children's California Health Interview Survey data. RESULTS: An estimated 252,399 (6.8%) of 3,729,786 California children ages 5 to 11 received at least one mental health service in the prior year. Bivariate analysis revealed significant associations with age, race (Asian), household size, birthplace of child and parents, age of parents, usual source of care, insurance, doing poorly in school, and mental health variables. In the multivariable logistic regression analysis, of predisposing and enabling variables, only age (odds ratio [OR] = 1.1) and ...

ABSTRACT Mental illness is associated with increased risk of diabetes and sub-optimal diabetes care. Diabetes care in a sample of Medicaid-eligible adults (ages 18-59) served by the San Bernardino County (California) Department of Behavioral Health during late 2004 was examined. Publicly-funded services provided to 4,071 adults between May 2004 and April 2005 were extracted from the State's paid claims file. Co-morbid diabetes (ICD-9 code 250.xx) was found in 405 (10%) patients. Chi-squared and t-tests revealed that those with diabetes were significantly older (44.5 vs. 38.6 years of age), female (70% vs. 61% of all patients), less likely to be white (44% vs. 52%), and more likely to be diagnosed with schizophrenia (43% vs. 36%). Adherence to American Diabetes Association guidelines for quality of care was examined by searching claims for CPT codes indicating lipid testing, HbA1c testing, and eye examinations. Only 61 patients (15.1% of 405) received all three services during the year, while 57.3% received lipid testing, 51.4% received HbA1c testing, and 32.1% received eye exams. There was no disparity in diabetes care due to age, gender, race/ethnicity, and psychiatric diagnosis. However, married status was associated with a higher likelihood of receiving all three diabetic services (34% vs. 17%, p=0.002). Patients receiving outpatient mental health services from a private physician were more likely to have lipids testing (24% vs. 9% of patients, p<0.001) and eye exams (24% vs. 15%, p=0.028). Extra effort is needed to ensure that patients in public mental health clinics receive recommended diabetes care.

Objective: Asian-Americans are the fastest growing population in U.S. Addressing this heterogeneous group simply as Asian-Americans has limited the ability to identify high risk groups, especially related to cardiovascular health outcomes. As such, this study evaluated the association between acculturation and current smoking behavior among six Asian-American subgroups in California. Methods: A secondary analysis of public access 2007, 2009, and 2011 California Health Interview Survey data was conducted. Univariate and multivariable logistic regression analyses were utilized with being a current smoker as the outcome variable and language spoken at home and generational status as proxy measures of acculturation. Potential covariates during model building included sociodemographic variables, health status, and survey year. Results: Linguistic acculturation (speaking only English at home versus native language at home) was associated with lower odds of being a current smoker among Jap...

To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin A 1 C checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin A 1 C checks. The findings highlight a specific area--foot complication evaluation and prevention--for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

To evaluate the relationship between self-reported mental health and binge drinking, as well as health status, sociodemographic, social support, economic resource, and health care access indicators to antihypertension medication adherence. Analysis of 2003 California Health Interview Survey data. Having poor mental health days predicted medication nonadherence, whereas binge drinking did not. Nonadherence predictors included younger age, Latino, non-US citizen, uninsured, less education, and no regular medical care. Adherence predictors were older age, African American, having prescription insurance, a college degree, poor health, comorbid diabetes or heart disease, and overweight or obese. Better mental health may improve medication adherence among hypertensive individuals.

This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking. Data were from the 2007 and 2009 California Health Interview Surveys. The 98 662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency. Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval = 30.5-31.4%) of men and 18.0% (17.7-18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among "Other Latino" women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by "Other Latino" women, 13.6%. These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.

The purpose of this study was to determine patient and hospital characteristics associated with 4 measures of quality of inpatient heart failure care used by both the primary payer of heart failure care in the United States (Center for Medicare and Medicaid Services) and the main hospital accrediting organization (The Joint Commission). We used data from Get With The Guidelines Program for patients hospitalized with heart failure. Eligibility for receiving care based on the Center for Medicare and Medicaid Services performance measures was determined for assessment of left ventricular ejection fraction (LVEF; n = 60,601), use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) if LVEF<40% and no contraindications (24,130), discharge instructions (49,383), and smoking cessation counseling (10,152). Patient and hospital characteristics that were significantly associated with performance measures in univariate analyses were entered into multivariate logistic regression models. Overall, documentation for LVEF assessment was noted in 95%, ACEi/ARB use in 87%, discharge instruction in 82%, and smoking cessation counseling in 91% of eligible patients. In adjusted analyses, older patients and those with evidence of renal failure were significantly less likely to receive each care measure except for discharge instructions (no age effect). Patients with higher body mass index were more likely to receive ACEi/ARB and discharge instructions but less likely to have LVEF documented or to receive smoking cessation counseling. Small hospitals (<200 beds) were less likely to provide each of the performance measures compared with larger hospitals. Recommended heart failure care is less likely in patients with certain characteristics (older age and abnormal renal function) and those cared for in smaller hospitals. Programs to improve evidence-based care for heart failure should consider interventions specifically targeting and tailored to smaller facilities and patients who are older with comorbidities.

Background Serious mental illness often is associated with an increased risk of diabetes and sub-optimal diabetes care. Objective To examine diabetes prevalence and care among Medicaid patients from one county mental health system. Design Retrospective cohort study combining county records and 12 months of state Medicaid claims. Subjects Patients ages 18 to 59 receiving mental health services between November 1 and 14, 2004. Measurements Dependent variables were glycolated hemoglobin A1C (HbA1c) testing, lipid testing, and eye examinations. Psychiatric status was assessed by second generation antipsychotic prescription (SGA) and low Global Assessment of Functioning (GAF) score. Results Among psychiatric patients, 482 (11.8%) had diabetes. Among those with diabetes, 47.3% received annual HbA1c testing, 56.0% lipid testing, and 31.7% eye examinations. Low GAF scores were associated with lower likelihood of lipid testing (OR 0.43). SGA prescription reduced the likelihood of HbA1c testing (OR 0.58) but increased the likelihood of eye examinations (OR 2.02). Primary care visits were positively associated with HbA1c and lipid testing (ORs 5.01 and 2.21, respectively). Patients seen by a fee-for-service psychiatrist were more likely to have lipid testing (OR 2.35) and eye examinations (OR 2.03). Conclusion Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios < 1, p < .05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios > 1, p < .05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.