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Hacker, Karen

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Hacker

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Hacker, Karen

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2012 - 20152

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Author's Publications: search.filters.isAuthorOfPublication.d1bad70e-c88d-442c-acc2-5a3cde0e7430

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    Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization
    (American Psychiatric Publishing, 2015) Hacker, Karen; Penfold, Robert B.; Arsenault, Lisa Nicole; Zhang, Fang; Soumerai, Stephen; Wissow, Lawrence S.
    Objective The study sought to determine the impact of a pediatric behavioral health (BH) screening and co-location model on BH care utilization Methods In 2003, Cambridge Health Alliance, a Massachusetts public health system introduced BH screening and co-location of social workers within its pediatric practices in a sequential manner. An interrupted time series study of the change in trends of ambulatory, emergency and inpatient BH utilization in the 30 months following model implementation compared to the 18 months prior was conducted to determine the impact of this model on BH care utilization, Utilization data on 11,223 children ≥4 years 9 months to < 18 years 3 months seen from 2003 to 2008, contributed to the study. Results In the 30 months following implementation of pediatric BH screening and co-location there was a 20.4% cumulative increase in specialty BH visit rates (trend = 0.013% per month; p=0.049), and 67.7% cumulative increase in BH primary care visit rates (trend = 0.019% per month; p=0.002) compared to the expected rate predicted by the 18 month pre- intervention trend. In addition, BH emergency department visit rates increased 245% compared to the expected rate (trend = 0.01% per month; p<.001). Conclusions Following the implementation of a BH screening/co-location model, more children received BH treatment. Contrary to expectations, BH emergency department visits also increased. Further study is needed to determine if this is an effect of how care was organized for children newly engaged in BH care or a reflection of secular trends in BH utilization or both.
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    Exploring the Impact of Language Services on Utilization and Clinical Outcomes for Diabetics
    (Public Library of Science, 2012) Hacker, Karen; Choi, Yoon Susan; Trebino, Lisa; Hicks, LeRoi S.; Friedman, Elisa; Blanchfield, Bonnie; Gazelle, G.
    Background: Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes. Methods/Principal Findings: To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (p<0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation. Conclusions/Significance: Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care.