Exposure to antipsychotic medications over a 4-year period among children who initiated antipsychotic treatment before their sixth birthday.

PURPOSE: This study aims the following: (i) to describe the exposure to antipsychotic medications over a 4-year period experienced by a cohort of children who initiated antipsychotic treatment before their sixth birthday; and (ii) to identify variables associated with the risk of antipsychotic exposure. METHODS: Children were identified who initiated an index episode of antipsychotic treatment before their sixth birthday in Florida's fee for service Medicaid program. With the use of claims data, the medication utilization of these children was tracked during the year before and the 4 years following the start of their index episodes (pre-index and four post-index periods). Generalized estimating equations were used to identify variables associated with the risk of additional days of antipsychotic exposure. RESULTS: Five hundred twenty-eight children were included in the cohort. The mean total number of days of exposure was 821.9 (± 431.9), representing 56.3% of all days during the four post-index periods. The mean days of exposure to combinations of antipsychotics and other classes of psychotherapeutic medications were 623.8 ± 447.6 days. Children with primary diagnoses of pervasive developmental disorders and affective disorders were at greater risk of additional days of exposure than children with attention deficit/hyperactivity disorder. Exposure tended to be greater among children with indicators of clinical complexity including the presence of secondary diagnoses and the use of other classes of psychotherapeutic medications in addition to antipsychotics. CONCLUSIONS: Exposure to antipsychotic mediations was extensive. Although these children may have had complex and severe problems, additional research is urgently needed on the benefits and risks of long-term antipsychotic exposure among very young children.

Reducing unnecessary medicare admissions: a six-state project.

PURPOSE/OBJECTIVES: The Centers for Medicare & Medicaid Services funded a project in six western states to decrease the payment error rate in short-stay admissions (< or =2 days) and decrease the number of inpatient discharges for short stays. Seventeen hospitals were recruited to implement the Case Management Assignment Protocol (CMAP), which standardizes the decision-making process at admission, thereby increasing the number of hospitalized patients assigned to the correct status of inpatient or observation. PRIMARY PRACTICE SETTING: Acute care hospitals. FINDINGS/CONCLUSIONS: Based on the decrease in unnecessary admissions and the relationship between use of the protocol and correct admission status, the project demonstrated that the CMAP was effective in ensuring that patients were placed in the appropriate status. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: 1. Case managers can play a key role in correct assignment of patient status through the use of the CMAP. 2. Hospitals that were successful in implementing the protocol had highly involved senior management, stable corporate environments, physician buy-in, physician champions, policies for mandatory use within the facilities, support from all team members, and "out-of-the-box" thinking for case management coverage. 3. Staffs at hospitals that implemented the protocol indicate they are well positioned for the Recovery Audit Contractor program, which began as a 3-year demonstration project and is now being implemented. It will be in place nationally by 2010.