Past Service Use Research Articles

Anticipating multisectoral use of services with the support of AI

Introduction: This paper presents the preliminary results of a collaborative R&D project which aims at developing artificial intelligence (AI) supported anticipation of multisectoral use of services. If we were able to predict the escalation of health and social problems of clients and the use of several different services, we could plan and offer them early preventive services with the objective of improving the quality of life and reducing the costs of service provision in the longer term.
 Approach and methods: The multidisciplinary project in progress collaborates at four spheres of research and development within the elderly care of one welfare region in Finland.
 1) Anticipatory management practices concerning risk client groups and anticipatory case management practices concerning individual clients in risk are being developed supported by predictive AI technology. The requirements concerning the information the AI based prediction model should produce to the managers and to the case managers have provisionally been defined. The current practices are co-studied, and the new practices supported by AI are co-designed by involving the “relevant” health and social care managers and practitioners in the welfare region.
 2) A machine learning (ML) predictive model based on health and social care data is being developed. The prediction model will be developed based on retrospective analysis of health and social data of the welfare region. The available data includes clinical data recorded during healthcare encounters, decisions, and usage of social services as well as physical function assessments. The data is used to train and test potential machine learning algorithms for predicting future service use of the elderly individuals based on their current health status and past use of services.
 3) The implementation of the AI/ML model within the IT infrastructure and information systems (IS) in use will be supported and investigated. The developed ML model would eventually be integrated into the IT/IS environment of the case organization. That entails connecting the specific data sources, running the model computations, and passing the results to the digital workflow of the care production management for knowledge management.
 
 4) The EU and Finnish legislation that regulate the use of personal health and social data in the development and use of AI based predictive models is being analyzed. Requirements and potential limitations imposed by current legislation on the use of predictive models are identified. In particular, the strict conditions applicable to making automated risk assessments of individuals for purposes of taking anticipatory measures are analyzed and avenues for meeting them by health and social care organizations are discussed.
 Results and outputs: Working on these four spheres, the project produces a generic model on developing the anticipation practices of multisectoral use of services with the help of AI technology. The model will available to all the organizations which are developing AI based anticipation of multisectoral use of services.
 Key words: Anticipation, prediction, health and social services usage, machine learning model, AI software, legislation, elderly care

Community expectations and anticipated outcomes for crisis support services-Lifeline Australia.

Crisis lines provide a critical first line of mental wellbeing support for community members in distress. Given the increasing referral to such services, there is a need to understand what the expectations of the community are around the role of such services in our public health responses. A computer assisted telephone interview was undertaken between 28th October and 30th November 2019. The aim was to explore expectations and anticipated outcomes of Lifeline Australia's crisis support services from a nationally representative community sample (N=1,300). Analysis was undertaken to determine if demographic variables (age, gender, indigenous status, country of birth, culturally and linguistically diverse (CALD) status, sexual orientation, household composition, region and State/territory) and past service use affected community expectations. Results showed that a majority of respondents expected Lifeline to listen and provide support, recommend other services, and provide information. Help-seekers were expected to feel heard and listened to, receive safety advice or support to stay safe, and feel more hopeful. Lifeline was expected to prioritise people feeling suicidal, in immediate personal crisis, and experiencing domestic violence. Findings reveal that community members hold expectations for Lifeline Australia to serve as a suicide prevention and general crisis support service, which are congruent with the service's aims. There was little variation in community expectations of crisis support services based on demographic factors and past service use. The results show that the community has extensive and diverse expectations for this national crisis service to meet both short and longer-term needs for all vulnerable members of the community-entailing a very substantial public health service responsibility.

Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.

Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures.

Longitudinal Predictors of Behavioral Intentions and HIV Service Use Among Men Who Have Sex with Men.

HIV prevention interventions are generally effective at reducing sexual risk. Although these interventions have been widely disseminated in the USA, their success depends largely on whether subpopulations who have been prioritized for risk reduction are willing to participate. Understanding the factors predicting service utilization is critical to maximizing public health benefit. HIV-negative men who have sex with men (MSM) (n=613) were enrolled in a longitudinal study investigating whether theoretically derived psychosocial variables (past behavior, cues to action, perceived susceptibility, positive expectations, perceived barriers, personal discomfort, and recent condomless anal intercourse) predicted intentions to use HIV prevention services and service use behavior across multiple categories (information seeking, structured service use, HIV testing, and volunteering/working in prevention services). Cues to action (including life events such as friend's recent HIV diagnosis) and past service use emerged as the most consistent predictors of intentions and actual service use. Perceived susceptibility, positive expectations, and condomless anal intercourse predicted some categories of service use indirectly through intentions. Contrary to predictions, perceived barriers and personal discomfort predicted intentions but were not predictors of service use. Intentions generally predicted behavior, with the exception of structured service use. This study addressed methodological limitations of prior research and utilized data from a longitudinal sample of MSM to discover predictors of access to HIV prevention services. Understanding who accesses HIV services and why will allow for directed strategies to improve dissemination and utilization.

Development of a novel observational measure for anxiety in young children: The Anxiety Dimensional Observation Scale.

Identifying anxiety disorders in preschool-age children represents an important clinical challenge. Observation is essential to clinical assessment and can help differentiate normative variation from clinically significant anxiety. Yet, most anxiety assessment methods for young children rely on parent-reports. The goal of this article is to present and preliminarily test the reliability and validity of a novel observational paradigm for assessing a range of fearful and anxious behaviors in young children, the Anxiety Dimensional Observation Schedule (Anx-DOS). A diverse sample of 403 children, aged 3 to 6 years, and their mothers was studied. Reliability and validity in relation to parent reports (Preschool Age Psychiatric Assessment) and known risk factors, including indicators of behavioral inhibition (latency to touch novel objects) and attention bias to threat (in the dot-probe task) were investigated. The Anx-DOS demonstrated good inter-rater reliability and internal consistency. Evidence for convergent validity was demonstrated relative to mother-reported separation anxiety, social anxiety, phobic avoidance, trauma symptoms, and past service use. Finally, fearfulness was associated with observed latency and attention bias toward threat. Findings support the Anx-DOS as a method for capturing early manifestations of fearfulness and anxiety in young children. Multimethod assessments incorporating standardized methods for assessing discrete, observable manifestations of anxiety may be beneficial for early identification and clinical intervention efforts.

Pediatric primary care services in Manitoba: Is the health of the next generation of children at risk?

ObjectivesPhysician resource planning is an important part of health policy, but to date there are no studies measuring the primary care service needs of a particular population. The aim of this study was to project the expected provision of physician services for the pediatric population of one Canadian province for 2020. MethodsA novel standardized measure of physician service provision, the equivalent services measure, was developed using mathematical modeling. Population projections and past use of services were used to calculate the projected service needs for the pediatric population of Manitoba. ResultsDespite projecting a small increase in the pediatric population (2.8%), our model predicted a decrease of 13.4% in the services that would be provided. ConclusionsThe findings of this study indicate that the health of future generations of children may be at risk. Further research is needed to determine the effect of the reduction in pediatric service provision on the health of the pediatric population.

P-631 - Epidemiology and predictors of compulsary admissions in flanders, belgium. a general-population perspective (2007–2009)

Introduction Epidemiological data regarding compulsory admission are mainly limited to unpublished reports and databases, often gathered unsystematically with great heterogeneity in both definitions and data recording methods. The scarcity of scientifically validated and published data is in sharp contrast with the societal relevance of coercion. Therefore the Flemish Community implemented since 2007 a uniform data collection and recording method inspired by the Dutch registration, resulting in a database of incident cases of compulsory admission. Objectives and aims (a) to investigate the epidemiology of compulsory admission in Flanders in terms of sociodemographic and psychiatric characteristics, past use of services, and temporal trends; (b) to compare Flemish epidemiological profiles with Belgian population-representative data (N = 7,821; 1997–1998) and data gathered from a Belgian university teaching hospital (N = 1,501; 2000–2010). Methods Data were systematically collected and quality controlled by a government agency, supervised by a scientific committee. All incident cases of compulsory admission were included prospectively (2007–2009, N = 10,607, response rate=100%). Descriptive statistics, advanced uni- and multivariate regression models and time-trend models were applied. Results Epidemiological profiles of prevalence and incidence data comprising data from all three sources will be presented. Data will be disaggregated by sociodemographic profiles (e.g. gender/age comparisons), psychiatric disorders, severity estimates, correlates of compulsory admissions, and temporal trends in these disaggregation variables. Conclusions This is the first study investigating the epidemiology of compulsory admissions in Belgium using large and longitudinal databases. Our findings will be placed into an international context relating to implications for further epidemiological research, legislative issues, and methodological improvements.

Perceived Barriers to Mental Health Services Among Youths in Detention

To examine perceived barriers to mental health service use among male and female juvenile detainees. The sample included 1,829 juveniles newly detained in Chicago. The Diagnostic Interview Schedule for Children and Children's Global Assessment Scale were used to determine the need for services. Service use and barriers to services were assessed with the Service Utilization and Risk Factors interview. Approximately 85% of youths with psychiatric disorders reported at least one perceived barrier to services. Most common was the belief that problems would go away without help. Generally, attitudes toward services were remarkably similar across sex and race. Among females, significantly more youths with past service use or referral to services reported this barrier than did youths who had never received or been referred to services. Among males, significantly more youths who had been referred, but never received, services were unsure about where to go for help than youths with past service use. Significantly more youths with no past service use or referrals were concerned about the cost of services than youths with past service use. Despite the pervasive need for mental health services, the findings of this study suggest that detained youths do not perceive the mental health system as an important or accessible resource. Youths who believe their problems can be solved without assistance are unlikely to cooperate with referrals or to independently seek mental health services. Service providers must be sensitive to clients' perceived barriers to mental health services and work to reduce negative perceptions of services.

Latino immigrants' intentions to seek depression care.

This study examined the role that illness perceptions, attitudes toward depression treatments, and subjective norms played in Latino immigrants' intentions to seek depression care. Ninety-five Latino immigrant patients were presented a vignette depicting an individual with major depression and interviewed about their intentions to seek care if confronted with a similar situation. Patients' preferences were to rely on informal sources of care first, and then turn to formal sources to cope with depression. Findings showed Latinos immigrants' help-seeking intentions for depression were a function of their views of depression, attitudes toward their doctors' interpersonal skills, and social norms related to seeking professional care after controlling for demographics, health insurance status, acculturation, clinical characteristics, perceived barriers to care, and past service use.

“It’s Like Being in a Labyrinth:” Hispanic Immigrants’ Perceptions of Depression and Attitudes Toward Treatments

This study aimed to describe Hispanic immigrants' perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients' views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants' perceptions and attitudes into depression treatments.

Perceptions of the Availability, Accessibility, and Adequacy of Domestic Violence Services

This study examined the perceptions of the availability, accessibility, and adequacy of domestic violence services. It was predicted that there would be differences in the perceptions of domestic violence services between victims using services, victims not using services, and non-victims. In addition, it was expected that the degree of use of services will positively correlate with the perception of services, and past use of services will predict current use of services. Participants included 160 adults from an urban city in a mid-western area of the U.S.A. recruited by contacting individuals based on police reports, residence in shelters, and use of the local library. As predicted, results indicated that there are differences between victims using services, victims not using services, and non-victims; victims not using services had significantly lower perceptions of domestic violence services than the other two groups; and past usage of services predicted current usage. Directions for future research are discussed. Gender & Behaviour Vol.3 2005: 334-347

Prospective Cost Allocations for the Chronic Schizophrenic Patient

Schizophrenia affects from 0.5 percent to 1.0 percent of the population and is often a chronic relapsing illness with high morbidity. Because it strikes young adults, the lifetime direct and indirect costs are considerable. One method of budgeting the costs of treatment is through a prospective method with the development of "risk-adjusted" capitation rates that take into account a patient's past use of services, perceived health status, and level of disability. Such a system may provide opportunities to improve the quality of mental health services by increasing service flexibility, particularly in the development and differentiation of outpatient services. The essence of the approach is to encourage early intervention by reducing financial barriers for patients, especially barriers to alternatives to expensive inpatient services. One method currently employed in Rochester, New York, which creates a capitation payment system for the chronically mentally ill, will be described. The implications of this system for public policy will be discussed as we struggle to treat and care for chronic schizophrenic patients in humane and compassionate ways.