Vickie Mays

The ICD-10-CM classification system contains more specificity than its predecessor ICD-9-CM. A stated reason for transitioning to ICD-10-CM was to increase the availability of detailed data.

This study aims to determine whether the increased specificity contained in ICD-10-CM is utilized in the ambulatory care setting and inform an evidence-based approach to evaluate ICD-11 content for implementation planning in the United States.

Diagnosis codes and text descriptions were extracted from a 25% random sample of the IQVIA Ambulatory EMR-US database for 2014 and 2019. Code utilization data was analyzed for the total and unique number of codes. Frequencies and tests of significance determined the percentage of available codes utilized and the unspecified code rates for both code sets in each year.

Findings: Only 44.6% of available ICD-10-CM codes were used compared to 91.5% of available ICD-9-CM codes. Of the total codes used, 14.5% ICD-9-CM codes were unspecified, while 33.3% ICD-10-CM codes were unspecified.

Even though greater detail is available, a 108.5% increase in using unspecified codes with ICD-10-CM was found. The utilization data analyzed in this study does not support a rationale for the large increase in the number of codes in ICD-10-CM. New technologies and methods are likely needed to fully utilize detailed classification systems.

These results help evaluate the content needed in the United States national ICD standard. This analysis of codes in the current ICD standard is important for ICD-11 evaluation, implementation, and use.

Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. Authors used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use.

This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. Researchers assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department.

Findings: Of the 8,112 patients, most were male (74.8%), white (55.8%), and privately insured (35.2%). Overall, 8.1% were restrained with 7.1% chemically restrained and 2.7% physically restrained. Overall restraint use increased 254% from 2016 to 2022 driven primarily by a 460% increase in chemical restraint use including a 630% increase in ketamine administrations. Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance. Chemical restraint administration was associated with a 3.5 percentage point increase in the probability of ICU admission and a 1.0 day increase in hospitalization duration.

In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation.

Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.
 

This special issue of the American Journal of Public Health (AJPH), co-edited by UCLA Professor and UCLA CHPR Senior Fellow Vickie Mays, PhD, and UCLA Professor Susan Cochran, PhD, addresses improving the conditions that promote mental health and prevent mental disorders.

The papers explore innovations to infuse a public mental health agenda more thoroughly into interventions, research, and legislative and social policies. 

Topics include the impact of COVID-19 on youths and the need for public health policy advisories that focus on mental health consequences in addition to infection control; the increasing rates of suicide among Black youths, some as young as 5 years of age; the importance of primary care referrals that consider gendered differences in the expression of distress; the history of racism that continues to affect the diagnoses and treatment of African Americans; and the impact of the devastating fire in Lahaina on residents' well-being.

Read the Publication:

• Special AJPH issue: The Social Context of Mental Health, Bereavement, and Grief 

Mays also co-authored the following articles in the issue:

• Journal Article: Society’s Role in Addressing Mental Health, Grief Crisis: A Call for Public Support 
• Journal Article: Societal Mental Health Challenges: Advocating for a National Policy Response
• Journal Article: Gendered Patterns in Manifest and Latent Mental Health Indicators Among Suicide Decedents: 2003–2020 National Violent Death Reporting System (NVDRS)
   

Summary: The Latino population is one of the largest immigrant groups in the United States, with the majority being of Mexican descent. Whether immigrating to the U.S. is positive for the well-being of Mexican immigrants and future generations is an important question. Authors examined how nativity status and quality of life indicators relate to life satisfaction among foreign-born and U.S.-born Mexican descent Latinos living in California. Participants were from the California Quality of Life Survey, a population-based mental health survey of the California population. 

Findings: Multiple regressions examining sociodemographic and indicators of life satisfaction found higher life satisfaction among the foreign-born compared to U.S.-born: females and individuals reporting more social support, absence of frequent distress, and better physical health. Life satisfaction was lower for U.S.-born Mexicans than for Mexican immigrants. Research, interventions, and policies are needed for mental health equity that address this lack of well-being in U.S.-born Mexican Latinos.

This study uses 2007 and 2012–2012 California Health Interview Survey (CHIS) data.

Read the Publication

• Journal Article: The American Dream: Is Immigration Associated with Life Satisfaction for Latinos of Mexican Descent?