Banahan, III B.

Clark, J.P.

Harwick, S.P.

Nunna, S.

Shah, R.

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 VA L U E  I N  H E A LT H  1 8  ( 2 0 1 5 )  A 1 – A 3 0 7  A275
was implemented. Tally sheets were used to categorize clinicians counter referral 
comments. Results: The study engaged 4 clinicians who made 132 counter-referral 
comments on referral slips delivered to them from CHWs. The comments were 
categorized into seven themes as indicated below. The theme “service provided 
and patient counter-referred to CHW” accounted for 40% (53/132); “continue with 
treatment” 16% (21/132);“medicine/treatment given” 15%(20/132); “patient advised 
to attend ANC, PNC and MCH/FP clinic” 12% (16/132); “patient recommended for 
further referral” 7%(9/132); “patient seen” 7% (9/132) and the theme “ patient advised 
to come again” accounted for 3% (4/132.) ConClusions: Clinicians should take an 
active role in supporting and mentoring community health workers and ensuring 
that all members of households have access to healthcare. They need to recognize, 
appreciate and support their efforts. The referral and counter-referral comments 
made by both clinicians and CHWs acted as a perfect link between the two levels 
of healthcare.
PHS167
Are evidence-bASed PrActiceS ASSociAted witH effective Prevention 
of HoSPitAl-Acquired PreSSure ulcerS in u.S. HoSPitAlS?
Padula W.1, Gibbons R.D.1, Valuck R.J.2, Makic M.B.2, Meltzer D.1
1University of Chicago, Chicago, IL, USA, 2University of Colorado, Aurora, CO, USA
objeCtives: In 2008, Medicare established nonpayment policy for HAPU incidences, 
prompting hospitals to adopt quality improvement (QI) interventions that could 
support implementation of evidence-based practices (EBPs) for HAPU prevention. 
The objective of this study is to evaluate the longitudinal impact of CMS policy and 
EBP implementation on HAPU incidence. Methods: We characterized longitudi-
nal adoption of 25 QI interventions to implement EBPs. Counts of quarterly HAPU 
incidence were collected at the hospital-level from 55 University HealthSystem 
Consortium (UHC) hospitals between 2007-2012. We also monitored time points 
when QI interventions resulted in direct improvements to implementation of EBPs. 
Two-level mixed effects Poisson regression with empirical Bayes estimates models 
were developed to test the longitudinal association between CMS policy, EBPs and 
HAPU incidence by hospital-quarter. First, a model tested the effects of 25 categorical 
QI interventions bundled with EBPs as indicated by hospitals. Second, a model tested 
the effect of hospital-wide implementation of EBPs on HAPU incidence, controlling 
for EBP-time interaction. Each model included fixed effects for QI interventions, 
CMS policy, age, and case-mix index. The models assumed level-2 random effects 
for intercepts, CMS policy and EBP implementation. Both models included an offset 
to control for variability in number of inpatient hospitalizations. Results: First, 
controlling for 25 categorical QI interventions, the EBPs for HAPU prevention had 
a significant effect on HAPU incidence (-0.1808 HAPU cases per quarter; p= 0.0325). 
CMS policy had the largest significant effect on HAPU incidence (-1.13 cases per 
quarter; p< 0.001). Second, direct effect of EBPs on HAPU incidence, not controlling 
for QI interventions, was greater (-0.27 cases per quarter; p= 0.002). The effect of 
time on HAPU incidence was significant in both models, approximately -0.03 cases 
per quarter. ConClusions: HAPU prevention is closely associated with increased 
adoption of QI interventions and improved implementation of EBPs for HAPU pre-
vention.
PHS168
AntiPSycHotic MedicAtion uSe MeASureS for cHildren And 
AdoleScentS: MetAbolic Screening for cHildren on AntiPSycHoticS
Banahan III B.1, Nunna S.1, Shah R.1, Harwick S.P.2, Clark J.P.2
1University of Mississippi, University, MS, USA, 2Mississippi Division of Medicaid, Jackson, MS, 
USA
objeCtives: While antipsychotics offer the potential for effective treatment of 
psychiatric disorders in children, they can also increase the risk for developing 
metabolic and physical complications. In 2013, the National Collaborative for 
Innovation in Quality Measurement (NCINQ) proposed a measure of metabolic 
monitoring for children taking antipsychotics be considered for use in Medicaid 
and CHIP programs. The current study evaluated how the Mississippi Medicaid 
program performs on the proposed quality measure. Methods: A retrospective 
analysis was conducted using Mississippi Medicaid medical claims, pharmacy 
claims and beneficiary eligibility data for the time period July 2013 to June 2014. 
Both fee-for-service (FFS) and managed care claims were used for the analysis. 
The measure specifications provided by NCINQ in their April 2013 call for public 
feedback on proposed new measures were used. The denominator for the measure 
was beneficiaries ages 0 and 21, as of June 30 2014, who were continuously enrolled 
for 3+ months and taking any antipsychotic medication. Numerators were benefi-
ciaries having 1+ cholesterol tests, 1+ blood glucose tests, and having both types 
of tests during the measurement year. Results: Around 30% of the children on 
antipsychotic medications had blood glucose test, 14% had cholesterol test, and 
13% had both the tests during the observation year. The percentage of children 
who had both metabolic monitoring tests was slightly higher in fee-for-service 
beneficiaries compared to managed care beneficiaries (13.4% in fee-for-service 
vs 11.4% and 12.9% in managed care plans). The percentage is also higher in chil-
dren of ages 12 to 20 compared to ages less than 11 years. ConClusions: Based 
on the performance rates provided by NCINQ for 11 state programs in 2008, the 
Mississippi Medicaid program currently performs at about the 25th percentile. 
Provider education has been undertaken to improve performance on this impor-
tant measure being developed for Medicaid programs.
PHS169
quAlity And iMPleMentAtion bArrierS of Prevention of MotHer to 
cHild trAnSMiSSion of Hiv ProgrAM in etHioPiA: A croSS SectionAl 
Study
Legesse B.
Karolinska Institutet, Stockholm, Sweden
objeCtives: The study aimed to assess the quality and implementation barri-
ers of prevention mother-to-child transmission of HIV(PMTCT) program in public 
prevalence of mental health disorders than did other ages. CNS stimulants, anti-
depressants, narcotic analgesics and antipsychotics are the most frequently used 
mental health drug categories. The total annual cost was highest for ADHD patients 
($191 million), followed by patients with oppositional defiance disorder ($115 mil-
lion). Access to mental health care varied by county with the Mississippi delta 
region having poorer access to care as measured by the proportion of in-county 
MD visits. ConClusions: Mental health disorders among children are a signifi-
cant burden to the Mississippi Medicaid. The prevalence of mental health disorders 
varies significantly among counties of the state. Children from some counties of 
Mississippi have poor access to mental health care services.
PHS163
iS tHe uPtAke of voluntAry MedicAl MAle circuMciSion influenced 
by level of educAtion, MAritAl StAtuS And MAin Source of incoMe? 
cASe Study of weStern kenyA
Mogere D.M.
Great Lakes University of Kisumu, Nairobi, Kenya
objeCtives: Male circumcision has been shown to be associated with lower trans-
mission of sexually transmitted infections including HIV. In Kenya factors that influ-
ence Voluntary Medical Male Circumcision include ethnicity, residence, level of 
education and age. The objective of the study was to establish whether level of 
education, marital status and main source of income influence uptake of voluntary 
medical male circumcision. Methods: A household baseline survey was carried 
out in two provinces in western Kenya e.g Nyanza and Western in which 1303 male 
heads of households were interviewed to determine whether they had been circum-
cised. Data analysis was done using SPSS version 16.0 in which cross-tabulations 
were generated, charts created and interpretation made for the three variables 
described below. Results: The study indicated that the proportion of men circum-
cised tended to increase as the level of education increased. Those who had tertiary 
level of education and above were more likely to get circumcised compared to those 
with no or primary education. Analysis indicated that those with no education were 
61% (36/59); primary education 65% (704/1085); secondary education 73 %( 94/129) 
and tertiary education and above 79 % (19/24). Marital status and main source of 
income did not seem to have effect on uptake. ConClusions: The study indicated 
that the proportion of men circumcised tended to increase as the level of education 
increased. Those who had tertiary level of education and above were more likely to 
get circumcised compared to those with no or primary education. Analysis indicated 
that those with no education were 61% (36/59); primary education 65% (704/1085); 
secondary education 73 %( 94/129) and tertiary education and above 79 % (19/24). 
Marital status and main source of income did not seem to have effect on uptake.
PHS165
iMPAct of coMMunity bASed tHerAPy on cHildren witH MentAl 
HeAltH diSorderS: A HeAltH tecHnology ASSeSSMent
Chahar A.1, Gulati R.1, Sharma J.1, Likhar N.2, Dang A.2
1National Health Systems Resource Centre, Division of Healthcare Technology, New Delhi, India, 
2MarksMan Healthcare Solutions LLP (HEOR and RWE Consulting), Navi Mumbai, India
objeCtives: The increasing prevalence of mental health disorders in children is a 
growing concern in India. Community based therapy, such as school based therapy 
(SBT) and psychotherapy (PT) is used in the treatment. This paper aims to inves-
tigate the disease burden of mental health disorders, and assess the clinical and 
economic impact (by cost-effectiveness analysis) of SBT and PT on the symptoms 
of depression in Indian children aged below 15 years. Methods: Health technology 
assessment by systematic review of published literature. An electronic literature 
search was performed in Cochrane Review, Elsevier, PubMed and Medline databases 
for randomized controlled trials and cohort studies pertaining to community based 
therapies, particularly SBT and PT, in Indian children aged below 15 years suffer-
ing from depression. RevMan 5.0 was used for data analysis and quantitative data 
synthesis. Cochrane Review Manager’s Risk of Bias Table was used to assess the 
risk of bias. Results: Out of 32 studies which were screened, 6 studies involving a 
total of 1,375 participants (377 received SBT, 325 received PT, 673 received neither) 
were included. In comparison with no therapy, SBT significantly reduced symptoms 
of depression: standard mean difference (SMD) -0.20 (95% confidence interval (CI) 
-0.35 to -0.04); PT significantly reduced symptoms of depression: SMD -0.64 (95% CI 
-1.44 to 0.16). Economic burden: a total of 95,295.50 DALY/year was lost due to the 
condition in specific the patient population. Assuming the cost of PT as INR 300 
(US$ 4.75) per session, INR 962,000 (US$ 15220.341) was required per year to avert 1 
DALY. By reducing the cost of each session by INR 50 (US$ 0.80), the PT can be made 
more cost-effective. ConClusions: SBT and PT are clinically and economically 
effective in reducing the symptoms of depression in Indian children aged below 15 
years suffering from depression.
PHS166
increASing HouSeHoldS’ AcceSS to HeAltHcAre; linking cliniciAnS to 
coMMunity HeAltH workerS tHrougH counter referrAl coMMentS
Mogere D.M., Loum C.S., Kaseje D.
Great Lakes University of Kisumu, Nairobi, Kenya
objeCtives: There is evidence that there is resistance from healthcare profession-
als to integrate community health workers into clinical care protocols. The reasons 
for this resistance vary. Some physicians/nurses do not believe that persons without 
professional training in healthcare can be trusted with responsibilities of taking 
care of patients. They view CHWs as not well trained to be trusted with patients 
care. The purpose of the study was to use counter referral slips to link clinicians to 
CHWs. Methods: Quasi -experimental study was carried out in two sub- locations 
in rural Kenya where one hundred CHWs were trained on community-based-referral 
and counter-referral model and issued with referral tools. Each was assigned 25 
households, instructed to regularly visit them in order to identify sick persons coun-
sel and refer them to link hospitals. One hundred villages comprising 2209 house-
holds with a population of 11,000 people were covered where the referral model 


PHS168 Antipsychotic Medication use Measures for children and adolescents: Metabolic Screening for children on antipsychotics 

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PHS168 Antipsychotic Medication use Measures for children and adolescents: Metabolic Screening for children on antipsychotics

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