Revolutionizing Child Welfare with Outcomes Management

Outcomes management technology holds great promise for improving the quality of services provided to youth in the child welfare system. Advantages include better detection of behavioral health and trauma-related issues, early indicators of case progress or risk of failure, and program- and system-level learning. Yet organizational barriers to implementation persist. Attention is spent in this paper on addressing these barriers so the use of outcomes management technology becomes a common practice. A model for predicting resiliency is presented, along with case examples demonstrating its potential use for treatment planning and monitoring progress.     

Women supporting women: Supportive/educative groups for ethnically diverse,urban, impoverished women dealing with depression and anxiety

Depression and anxiety are mental health issues that disproportionately affect urban, ethnically diverse, impoverished women. Using community based participatory research and in the context of long-term partnerships between a nursing department and underserved neighborhoods that are predominately Black, Hispanic, and White respectively, supportive/educative groups were offered. The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. Seventy-two women aged 17–88?years participated. Repeated measures ANOVA indicated a significant increase in knowledge for self-care for depression and anxiety and a significant decrease in anxiety and depression symptomatology from before to after the group sessions.     

An uncommon cause of dyspnea in the emergency department

Chest pain and shortness of breath are chief complaints frequently evaluated in the emergency department. ACS, pulmonary embolism, and disorders involving the lung parenchyma are some of the disease processes commonly screened for. Occasionally, patients presenting with histories and clinical exams consistent with these common illnesses may end up having more rare pathology. We present the case of a young patient who presented with chest pain and dyspnea with ECG changes and history concerning for pulmonary embolism who was ultimately diagnosed with idiopathic primary pulmonary hypertension. The importance of a prompt diagnosis of this condition along with emergency department management of complications related to the disease is discussed in this report.     

Travel Distance and Home Dialysis Rates in the United States

♦ Introduction: Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis.♦ Methods: This was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable logistic regression models.♦ Results: There were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4, 3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p < 0.01).♦ Conclusions: In metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.