Smita Das

All Publications

• Telemental Health Collaborative Care Medication Management: Implementation and Outcomes TELEMEDICINE AND E-HEALTH Das, S., Wang, J., Chen, S., Chen, C. E. 2021

  Abstract

  Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Materials and Methods: CoCM MM was available to adult employees/dependents through their employer benefits, in addition to therapy. Outcomes included Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) collected at baseline and throughout participation. This analysis was not deemed to be human subjects research by the Western Institutional Review Board. Results: Over 17 months, 212 people enrolled and completed >2 assessments; the enrollees were 58.96% female with average age of 32.00 years (standard deviation [SD] = 7.38). In people with moderate to severe depression or anxiety, PHQ-9 and GAD-7 scores reduced by an average of 7.27 (SD = 4.80) and 6.71 (SD = 5.18) points after at least 12 ± 4 weeks in the program. At 24 ± 4 weeks, the PHQ-9 and GAD-7 reductions were on average 7.17 (SD = 5.00) and 6.03 (SD = 5.37), respectively. Approximately 65.88% of participants with either baseline depression or anxiety had a response on either the PHQ-9 or GAD-7 at 12 ± 4 weeks and 44.71% of participants experienced remission; at 24 ± 4 weeks, 56.41% had response and 41.03% experienced remission. Conclusions: An evidence-based CoCM telemedicine service within an employee behavioral health benefit is feasible and effective in reducing anxiety and depression symptoms when using measurement-based care. Widespread implementation of a benefit like this could expand access to evidence-based mental health MM.

  View details for DOI 10.1089/tmj.2021.0401

  View details for Web of Science ID 000742611100001

  View details for PubMedID 34939839

• Primary Care Is Essential in Screening, Treating, and Referring People for Unhealthy Drug Use. American family physician Weissman-Ward, A., Das, S. 2021; 103 (12): 711-712

  View details for PubMedID 34128621

• E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics. Military medicine Dixit, D., Herbst, E., Das, S. 2020

  Abstract

  INTRODUCTION: Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions.MATERIALS AND METHODS: Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N=98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University.RESULTS: Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); chi2=9.259, P=0.010.CONCLUSIONS: Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.

  View details for DOI 10.1093/milmed/usaa292

  View details for PubMedID 33005932

• Problematic Use of a Smartphone Game Leading to Excessive Spending Kleinman, R., Das, S. WILEY. 2020: 216–17

  View details for Web of Science ID 000528341700047

• Excessive Spending in a "Free-to-Play" Smartphone Game. The American journal on addictions Kleinman, R. A., Das, S. n. 2020

  Abstract

  Although gaming disorder is increasingly recognized, there has been limited consideration of the impact of free-to-play games with in-game purchases, also called microtransactions.Case report (n = 1).A patient with posttraumatic stress disorder, major depressive disorder in remission, polysubstance use disorders in remission, and opioid use disorder on buprenorphine/naloxone developed gaming disorder (based on International Classification of Diseases, 11th revision) and spent up to 40% of his monthly income on microtransactions within a smartphone game. Treatment consisted of relinquishing access to electronic payment mechanisms, motivational interviewing, and couples therapy.The case highlights how in-game purchases may cause patients with gaming disorder to experience financial consequences, and the need for further characterization of the clinical ramifications of microtransactions.To the best of our knowledge, this is the first report in the medical literature of a patient with gaming disorder developing excessive in-game spending from expenditures on microtransactions. (Am J Addict 2020;00:00-00).

  View details for DOI 10.1111/ajad.13049

  View details for PubMedID 32353204

• The CBD Dialectic in Mental Health: Benign and Powerful? Psychiatric services (Washington, D.C.) Das, S. 2019: appips201900394

  View details for DOI 10.1176/appi.ps.201900394

  View details for PubMedID 31640523

• E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers. Journal of general internal medicine Fielding-Singh, P. n., Brown-Johnson, C. n., Oppezzo, M. n., Das, S. n., Jackler, R. n., Prochaska, J. J. 2019

  Abstract

  Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME).A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social).From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international.The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units.A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias.Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.

  View details for DOI 10.1007/s11606-019-05388-7

  View details for PubMedID 31630366

• Tobacco use disorder and treatment: new challenges and opportunities DIALOGUES IN CLINICAL NEUROSCIENCE Ziedonis, D., Das, S., Larkin, C. 2017; 19 (3): 271-+

  Abstract

  Tobacco use remains a global problem, and options for consumers have increased with the development and marketing of e-cigarettes and other new nicotine and tobacco products, such as "heat-not-burn" tobacco and dissolvable tobacco. The increased access to these new products is juxtaposed with expanding public health and clinical intervention options, including mobile technologies and social media. The persistent high rate of tobacco-use disorders among those with psychiatric disorders has gathered increased global attention, including successful approaches to individual treatment and organizational-level interventions. Best outcomes occur when medications are integrated with behavioral therapies and community-based interventions. Addressing tobacco in mental health settings requires training and technical assistance to remove old cultural barriers that restricted interventions. There is still "low-hanging fruit" to be gained in educating on the proper use of nicotine replacement medications, how smoking cessation can change blood levels of specific medications and caffeine, and how to connect with quitlines and mobile technology options. Future innovations are likely to be related to pharmacogenomics and new technologies that are human-, home-, and community-facing.

  View details for PubMedID 29302224

• Treating Smoking in Adults With Co-occurring Acute Psychiatric and Addictive Disorders. Journal of addiction medicine Das, S., Hickman, N. J., Prochaska, J. J. 2017

  Abstract

  Tobacco use is undertreated in individuals with psychiatric and substance use disorders (SUDs), with concerns that quitting smoking may compromise recovery. We evaluated outcomes of a tobacco intervention among psychiatric patients with co-occurring SUDs.Data from 2 randomized tobacco treatment trials conducted in inpatient psychiatry were combined; analyses focused on the subsample with co-occurring SUDs (n = 216). Usual care provided brief advice to quit and nicotine replacement therapy during the smoke-free hospitalization. The intervention, initiated during hospitalization and continued 6 months after hospitalization, was tailored to readiness to quit smoking, and added a computer-assisted intervention at baseline, and 3 and 6 months; brief counseling; and 10 weeks of nicotine replacement therapy after hospitalization. Outcomes were 7-day point prevalence abstinence from 3 to 12 months and past 30-day reports of alcohol and illicit drug use.The sample consisted of 34% women, among which 36% were Caucasian, averaging 19 cigarettes/d prehospitalization; the groups were comparable at baseline. At 12 months, 22% of the intervention versus 11% of usual care participants were tobacco-abstinent (risk ratio 2.01, P = 0.03). Past 30-day abstinence from alcohol/drugs did not differ by group (22%); however, successful quitters were less likely than continued smokers to report past 30-day cannabis (18% vs 42%) and alcohol (22% vs 58%) use (P < 0.05), with no difference in other drug use.Tobacco treatment in psychiatric patients with co-occurring SUDs was effective and did not adversely impact recovery. Quitting smoking was associated with abstinence from alcohol and cannabis at follow-up. The findings support addressing tobacco in conjunction with alcohol and other drugs in psychiatric treatment.

  View details for DOI 10.1097/ADM.0000000000000320

  View details for PubMedID 28441272

• Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders. Expert review of respiratory medicine Das, S. n., Prochaska, J. J. 2017; 11 (10): 841–50

  Abstract

  Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.

  View details for PubMedID 28756728

• Smoking, Mental Illness, and Public Health. Annual review of public health Prochaska, J. J., Das, S., Young-Wolff, K. C. 2016

  Abstract

  Tobacco remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of "the host" (e.g., tobacco user characteristics), the "agent" (e.g., nicotine product characteristics), the "vector" (e.g., tobacco industry), and the "environment" (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness. Expected final online publication date for the Annual Review of Public Health Volume 38 is March 20, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  View details for DOI 10.1146/annurev-publhealth-031816-044618

  View details for PubMedID 27992725

• Intravenous Use of Intranasal Naloxone: A Case of Overdose Reversal. Substance abuse Das, S., Shah, N., Ghadiali, M. 2016: 0

  Abstract

  Opioid overdose is a growing concern in the United States and internationally. Prehospital or pre-medical-personnel (lay person) administration of naloxone, an opioid antagonist, to reverse overdose, is an expanding mode of harm reduction. Recently, community clinics, methadone clinics, needle exchanges, some pharmacies and other health care facilities have made naloxone available to the community.This case describes heroin overdose reversal of a 28-year-old male who had been using about a gram of heroin intravenously for 3 years, but recently reduced frequency of use in an attempt to stop. He was seen initially 1 week prior to a buprenorphine induction in our clinic. After the initial intake he used intravenous heroin, a larger amount than over the past several weeks in anticipation of abstinence, lost consciousness and was difficult to arouse. A friend with him noted the patient's respirations to become shallow and administered naloxone nasal spray that the patient had obtained from a needle exchange, but did so intravenously by attaching an unused drug needle to the syringe barrel in place of the nasal atomizer. The patient's overdose was reversed and he recovered.This is the first known published case of a community-distributed naloxone nasal spray being used intravenously by a lay person (bystander). The case emphasizes the efficacy of naloxone in overdose reversal, and also the need for education or instructions on naloxone use by others (not just the user). Finally it highlights the risk of overdose in those entering treatment, seeking intoxication one last time.

  View details for DOI 10.1080/08897077.2016.1267686

  View details for PubMedID 27925864

• Smoking Trends Among Adults With Behavioral Health Conditions in Integrated Health Care: A Retrospective Cohort Study. Psychiatric services Young-Wolff, K. C., Kline-Simon, A. H., Das, S., Mordecai, D. J., Miller-Rosales, C., Weisner, C. 2016; 67 (9): 996-1003

  Abstract

  Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success with quitting, despite impressive gains in recent decades in reducing the overall prevalence of smoking in the United States. This study examined smoking disparities among individuals with BHCs within an integrated health care delivery system with convenient access to tobacco treatments.The sample consisted of patients in an integrated health care delivery system in 2010-a group (N=155,733) with one or more of the five most prevalent BHCs (depressive disorders, anxiety disorders, substance use disorders, bipolar and related disorders, and attention-deficit hyperactivity disorder) and a group (N=155,733) without BHCs who were matched on age, sex, and medical home facility. The odds of smoking among patients with BHCs versus without BHCs were examined over four years using logistic regression generalized estimating equation models. Tobacco cessation medication utilization among a subset of smokers in 2010 was also examined.Although smoking prevalence decreased from 2010 to 2013 overall, the likelihood of smoking decreased significantly more slowly among patients with BHCs compared with patients without BHCs (p<.001), most notably among patients with substance use and bipolar and related disorders. Tobacco cessation medication use was low, and smokers with BHCs were more likely than smokers without BHCs to utilize these products (6.2% versus 3.6%, p<.001).Smoking decreased more slowly among individuals with BHCs compared with individuals without BHCs, even within an integrated health care system, highlighting the need to prioritize smoking cessation within specialty behavioral health treatment.

  View details for DOI 10.1176/appi.ps.201500337

  View details for PubMedID 27079992

• Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions. Current psychiatry reports Das, S., Tonelli, M., Ziedonis, D. 2016; 18 (5): 51

  Abstract

  Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.

  View details for DOI 10.1007/s11920-016-0681-6

  View details for PubMedID 27040275

• Addiction Training: Striving to Fill an Unmet Need. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Das, S. n., Roberts, L. W. 2016

  View details for PubMedID 27020933

• Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome ALCOHOL AND ALCOHOLISM Maldonado, J. R., Sher, Y., Das, S., Hills-Evans, K., Frenklach, A., Lolak, S., Talley, R., Neri, E. 2015; 50 (5): 509-518

  Abstract

  The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients.We prospectively considered all subjects hospitalized to selected general medicine and surgery units over a 12-month period. Participants were assessed independently and blindly on a daily basis with PAWSS, Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) and clinical monitoring throughout their admission to determine the presence and severity of AWS.Four hundred and three patients were enrolled in the study. Patients were grouped by PAWSS score: Group A (PAWSS < 4; considered at low risk for complicated AWS); Group B (PAWSS ≥ 4; considered at high risk for complicated AWS). The results of this study suggest that, using a PAWSS cutoff of 4, the tool's sensitivity for identifying complicated AWS is 93.1% (95%CI[77.2, 99.2%]), specificity is 99.5% (95%CI[98.1, 99.9%]), positive predictive value is 93.1% and negative predictive value is 99.5%; and has excellent inter-rater reliability with Lin's concordance coefficient of 0.963 (95% CI [0.936, 0.979]).PAWSS has excellent psychometric characteristics and predictive value among medically ill hospitalized patients, helping clinicians identify those at risk for complicated AWS and allowing for prevention and timely treatment of complicated AWS.

  View details for DOI 10.1093/alcalc/agv043

  View details for Web of Science ID 000363934400004

  View details for PubMedID 25999438

• Smoking & Mental Illness: Strategies to Increase Screening, Assessment & Treatment The Journal of Lifelong Learning in Psychiatry Zidonis, D., Das, S., Tonelli, M. 2015; 12 (3): 290-306
• Chapter 144: Tobacco, Smoking and Mental Health Encyclopedia of Mental Health Das, S., Prochaska, J. J. Elsevier . 2015; 2
• Bus therapy: a problematic practice in psychiatry. JAMA psychiatry Das, S., Fromont, S. C., Prochaska, J. J. 2013; 70 (11): 1127-1128

  View details for DOI 10.1001/jamapsychiatry.2013.2824

  View details for PubMedID 24068366

• Cytisine, the world's oldest smoking cessation aid. BMJ (Clinical research ed.) Prochaska, J. J., Das, S., Benowitz, N. L. 2013; 347: f5198-?

  View details for DOI 10.1136/bmj.f5198

  View details for PubMedID 23974638

• Cytisine, the world’s oldest smoking cessation aid British Medical Journal Prochaska, J. J., Das, S., Benowitz, N. L. 2013; 347 (f5198)
• Infection and the Risk of Topical Anesthetic Induced Clinically Significant Methemoglobinemia after Transesophageal Echocardiography ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES Vallurupalli, S., Das, S., Manchanda, S. 2010; 27 (3): 318-323

  Abstract

  Methemoglobinemia is a recognized complication of topical anesthesia with benzocaine during transesophageal echocardiography (TEE). Though several risk factors have been described, the importance of individual factors is not known. We performed a retrospective study to identify determinants of the risk of methemoglobinemia.All patients who underwent TEE with benzocaine topical anesthesia between June 2005 and June 2007 were included in this retrospective study.Of the 886 patients who were included in the study, 140 had active infection (15.8%). The incidence of methemoglobinemia in this group was 2.9% (vs. 0%, P < 0.001). Compared to those without infection, patients in the active infection group were more likely to have a lower hemoglobin (P < 0.001), serum albumin level (P < 0.001), glomerular filtration rate less than 60 ml/min per 1.73 m(2) (P < 0.001), higher rates of dialysis (P < 0.001), a higher incidence of malignancy (P = 0.01), and increased use of acetaminophen and sulfa drugs (P < 0.001). However, multivariate logistic regression analysis did not identify any statistically significant covariates.In conclusion, patients with an active systemic infection who undergo TEE are at a higher risk of methemoglobinemia. However, none of the risk factors for methemoglobinemia including active infection reached statistical significance in the regression analysis which has to be interpreted with caution in view of the low event rate.

  View details for DOI 10.1111/j.1540-8175.2009.00994.x

  View details for Web of Science ID 000275757300017

  View details for PubMedID 19725841

• Clinical efficacy of beta1 selective adrenergic blockers in the treatment of neurocardiogenic syncope - a meta-analysis. Clinical pharmacology : advances and applications Vallurupalli, S., Das, S. 2010; 2: 163-167

  Abstract

  Beta1 (B(1)) selective blockers have been widely used for the treatment of neurocardiogenic syncope though clinical trials have shown conflicting degrees of efficacy.To study the clinical efficacy of B(1) selective blockers compared to placebo in the treatment of neurocardiogenic syncope.Four placebo controlled randomized studies were identified after search of existing English language literature. Review Manager (RevMan version 5, Oxford, England) was used for statistical calculations. Both random and fixed effects models were used for analysis.There was no demonstrable efficacy of B(1) blockers compared to placebo even after a pre-specified sensitivity analysis. There was a trend towards more adverse events in the beta blocker group compared to placebo (OR = 2.03 CI = 0.83-3.95, p = 0.12).There is no clinical evidence for justifying the use of B(1) selective blockers in the treatment of adult neurocardiogenic syncope. These agents may in fact lead to a higher rate of adverse events compared to placebo.

  View details for DOI 10.2147/CPAA.S12873

  View details for PubMedID 22291501

• Reliability of self-report: paper versus online administration COMPUTERS IN HUMAN BEHAVIOR Luce, K. H., Winzelberg, A. J., Das, S., Osborne, M. I., Bryson, S. W., Taylor, C. B. 2007; 23 (3): 1384-1389

  View details for DOI 10.1016/j.chb.2004.12.008

  View details for Web of Science ID 000244288900024

• Who pays for poor surgical quality? Building a business case for quality improvement JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Dimick, J. B., Weeks, W. B., Karia, R. J., Das, S., Campbell, D. A. 2006; 202 (6): 933-937

  Abstract

  Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications.We merged clinical data for 1,008 surgical patients from the private sector National Surgical Quality Improvement Program to the internal cost-accounting database of a large university hospital. We then determined the marginal costs of surgical complications from the perspective of both hospitals (changes in profit and profit margin) and payors (increase in reimbursement paid to the hospital). In our analyses of cost and reimbursement, we adjusted for procedure complexity and patient characteristics using multivariate linear regression.Reimbursement for patients without complications ($14,266) exceeded hospital costs ($10,978), generating an average hospital profit of $3,288 and a profit margin of 23%. When complications occurred, hospitals still received reimbursement in excess of their costs, but the profit margin declined: reimbursement ($21,911) exceeded hospital costs ($21,156), yielding an average profit of $755 and a profit margin of 3.4%. Complications were always associated with an increase in costs to health-care payors: complications were associated with an average increase in reimbursement of $7,645 (54%) per patient.Hospitals and payors both suffer financial consequences from poor-quality health care, but the greater burden falls on health-care payors. Strong incentives exist for health-care payors to become more involved in supporting quality improvement activities.

  View details for DOI 10.1016/j.jamcollsurg.2006.02.015

  View details for Web of Science ID 000238071300011

  View details for PubMedID 16735208

• Application of an algorithm-driven protocol to simultaneously provide universal and targeted prevention programs INTERNATIONAL JOURNAL OF EATING DISORDERS Luce, K. H., Osborne, M. I., Winzelberg, A. J., Das, S., Abascal, L. B., Celio, A. A., Wilfley, D. E., Stevenson, D., Dev, P., Taylor, C. B. 2005; 37 (3): 220-226

  Abstract

  Our objective was to develop a model to simultaneously prevent eating disorders and weight gain among female high school students.Of 188 female 10th graders enrolled in health classes, 174 elected to participate in the current study. They were assessed on-line and decided to participate in one of four interventions appropriate to their risk.The algorithm identified 111 no-risk (NR), 36 eating disorder risk (EDR), 16 overweight risk (OR), and 5 both risks. Fifty-six percent of the EDR and 50% of the OR groups elected to receive the recommended targeted curricula. Significant improvements in weight and shape concerns were observed in all groups.An Internet-delivered program can be used to assess risk and provide simultaneous universal and targeted interventions in classroom settings.

  View details for DOI 10.1002/eat.20089

  View details for Web of Science ID 000228875900005

  View details for PubMedID 15822091

• Dissemination of an effective inpatient tobacco use cessation program NICOTINE & TOBACCO RESEARCH Taylor, C. B., Miller, N. H., Cameron, R. P., Fagans, E. W., Das, S. 2005; 7 (1): 129-137

  Abstract

  The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.

  View details for DOI 10.1080/14622200412331328420

  View details for Web of Science ID 000228642300013

  View details for PubMedID 15804685

• Reliability of Self-Report: Paper versus Online Administration Computers in Human Behavior Luce, K. H., Winzelberg, A. J., Das, S., Osborne, M., Bryson, S. W., Taylor, C. B. 2003; 23 (3): 1384-1389