Barriers and facilitators to collaborative care implementation within the New York State Collaborative Care Medicaid Program.

BACKGROUND: Since 2015, the New York State Office of Mental Health has provided state primary care clinics with outreach, free training and technical assistance, and the opportunity to bill Medicaid for the Collaborative Care Model (CoCM) as part of its Collaborative Care Medicaid Program. This study aims to describe the characteristics of New York State primary care clinics at each step of CoCM implementation, and the barriers and facilitators to CoCM implementation for the New York State Collaborative Care Medicaid Program. METHODS: In this mixed-methods study, clinics were categorized into RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) steps. Clinics were sent a survey, which included questions related to payer mix, funding sources, billing codes used, and patient population demographics. Qualitative interviews were conducted with clinic representatives, focusing on barriers or facilitators clinics experienced affecting their progression to the next RE-AIM step. RESULTS: One thousand ninety-nine surveys were sent to primary care clinics across New York State, with 107 (9.7%) completing a survey. Significant differences were observed among the different RE-AIM steps for multiple demographic variables including primary payer, percentage of patients with a diagnose of depression or anxiety, and percent of behavioral health services that are reimbursed, in addition to others. Three main themes regarding barriers and facilitators to implementing CoCM for New York State Medicaid billing emerged from 31 qualitative interviews: (1) Billing requirements, (2) Reimbursement rates, and (3) Buy-in to CoCM. CONCLUSIONS: Survey data align with what we would expect to see demographically in NYS primary care clinics. Qualitative data indicated that CoCM billing requirements/structure and reimbursement rates were perceived as barriers to providing CoCM, particularly with New York State Medicaid, and that buy-in, which included active involvement from organizational leaders and providers that understand the Collaborative Care model were facilitators. Having dedicated staff to manage billing and data reporting is one way clinics minimize barriers, however, there appeared to be a disconnect between what clinics can bill for and the reimbursed amount several clinics are receiving, illustrating the need for stronger billing workflows and continued refinement of billing options across different payers.

Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study.

Introduction: Sepsis is a life-threatening condition. Nowadays, hospitals rely on laboratory parameters like CRP and procalcitonin to detect sepsis. There is a need to evaluate and validate more accurate and early predictors of sepsis in critically ill patients. We analyzed volume, conductivity, and scatter (VCS) parameters of leukocytes in sepsis patients and compared them with the control group with no illness. Materials and methods: It was a prospective case-control study. A total of 80 patients were studied with 40 sepsis cases and 40 controls. Peripheral smear examination was done in all the cases. Other parameters, such as WBC count, neutrophil%, absolute neutrophil count (ANC), High-sensitive C-reactive protein (hs-CRP), procalcitonin, and blood cultures were analyzed. We took the data of the patients from medical records and correlated it with other tests. Complete blood picture reports were generated by the Beckman Coulter LH series (LH 750 and 780). VCS parameters for neutrophils, lymphocytes and monocytes were compared between both groups. The results were analyzed using SPSS software (16.0 version). Results: The age group was 20-85 years with male predominance. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group when compared with the control group. The mean neutrophil conductivity and scatter was lower in the sepsis group and comparatively higher in the control group, but it was insignificant. The mean neutrophil volume values were higher in the sepsis group even with low total leukocyte count (TLC) when the patient had sepsis. There is no change in the mean lymphocyte VCS parameter and mean monocyte conductivity, scatter in both the groups. Conclusion: The mean neutrophil volume and MMV are found to be good sensitive markers in the prediction of sepsis. Even when TLC is on the lower side in patients with sepsis, these parameters predict sepsis accurately. This helps clinicians to assess sepsis in patients at an early stage and has an important practical implication. How to cite this article: Goyal H, Singhal A, Joseph M. Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study. Indian J Crit Care Med 2023;27(9):647-650.

Spatiotemporal transitions in Pseudo-nitzschia species assemblages and domoic acid along the Alaska coast.

The toxic diatom genus Pseudo-nitzschia is distributed from equatorial to polar regions and is comprised of >57 species, some capable of producing the neurotoxin domoic acid (DA). In the Pacific Arctic Region spanning the Bering, Chukchi, and Beaufort seas, DA is recognized as an emerging human and ecosystem health threat, yet little is known about the composition and distribution of Pseudo-nitzschia species in these waters. This investigation characterized Pseudo-nitzschia assemblages in samples collected in 2018 during summer (August) and fall (October-November) surveys as part of the Distributed Biological Observatory and Arctic Observing Network, encompassing a broad geographic range (57.8° to 73.0°N, -138.9° to -169.9°W) and spanning temperature (-1.79 to 11.7°C) and salinity (22.9 to 32.9) gradients associated with distinct water masses. Species were identified using a genus-specific Automated Ribosomal Intergenic Spacer Analysis (ARISA). Seventeen amplicons were observed; seven corresponded to temperate, sub-polar, or polar Pseudo-nitzschia species based on parallel sequencing efforts (P. arctica, P. delicatissima, P. granii, P. obtusa, P. pungens, and two genotypes of P. seriata), and one represented Fragilariopsis oceanica. During summer, particulate DA (pDA; 4.0 to 130.0 ng L-1) was observed in the Bering Strait and Chukchi Sea where P. obtusa was prevalent. In fall, pDA (3.3 to 111.8 ng L-1) occurred along the Beaufort Sea shelf coincident with one P. seriata genotype, and south of the Bering Strait in association with the other P. seriata genotype. Taxa were correlated with latitude, longitude, temperature, salinity, pDA, and/or chlorophyll a, and each had a distinct distribution pattern. The observation of DA in association with different species, seasons, geographic regions, and water masses underscores the significant risk of Amnesic Shellfish Poisoning (ASP) and DA-poisoning in Alaska waters.

Primary low-grade mucinous adenocarcinoma spleen resulting in Pseudomyxoma peritonei: A case report.

A 61-year-old man presented with complaints of abdominal pain, loss of weight, and splenomegaly since past 6 months. On computed tomography, the spleen was totally replaced by multiloculated cysts and splenectomy was performed. Pathological examination revealed a low-grade mucinous adenocarcinoma. Postoperative PET scan was negative, and in the absence of a primary tumor elsewhere, we considered this tumor to be primary in the spleen, and it was presumed that the tumor arose from invaginated capsular mesothelium of the spleen.

Synchronous bilateral ureteric metastasis from gastric cancer.

Distant metastasis to the ureters is uncommon. Moreover, isolated ureteric metastasis from gastric cancer is extremely rare and only sporadically reported. It indicates an advanced stage and carrier a very poor prognosis. We describe a case of synchronous bilateral ureteric metastasis from stomach adenocarcinoma after gastrectomy and chemoradiation. To our knowledge, it is the first case published in the literature with such presentation.

Tubercular splenic abscess in immunocompetent patients: a rare entity.

Splenic abscess is an unusual, potentially life threatening condition associated with septiceamic conditions. Splenic abscess due to tuberculosis is a rare entity, specifically seen in immunocompromised individuals. However splenic tubercular abscess in immunocompetent individuals is rarer. We present two cases of splenic tubercular abscess in immunocompetent persons where a diagnosis of tuberculosis was made after splenectomy. The aim of presenting these cases is to stress the fact that tuberculosis should be considered as a differential diagnosis in all cases of splenic abscesses in areas where tuberculosis is endemic.

Solid and papillary epithelial neoplasm of the pancreas--a case report.

Solid and papillary epithelial neoplasm (SPENP) of the pancreas is a rare pancreatic tumour of low malignant potential, that is seen mostly in young females. The aetiology and pathogenesis is unclear but it is considered to be arising from primordial pancreatic cells. We report two cases of SPENP who had palpable abdominal lumps and were diagnosed on histopathology. In the first case, the tumour was unresectable and patient died within one year. In the second case, at laprotomy the patient had perineurial as well as capsular infiltration but after wide resection of the growth, patient has been doing well for the past 6 months. Since SPENP is a low grade malignant neoplasm, it should be treated aggressively with complete resection and metastatectomy. Prognosis after adequate surgery is good. A clinicopathological study and brief review of literature is presented.