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Background: Hospitalized patients are frequently unprepared to care for themselves after discharge often leading to unplanned hospital readmission. One strategy to reduce readmission rates is improving the quality of patient education and preparation before hospital discharge. The ReEngineered Discharge (RED) is a standardized hospital-based program designed to provide patients and caregivers the information they need to continue care at home. Objectives: We sought to study the impact of the RED intervention on posthospitalization adult patient experience scores in an urban academic safety-net hospital. Methods: We conducted a descriptive study of a pilot program that compared posthospitalization survey responses to the Press Ganey survey item “Instructions were given about how to care for yourself at home.” We compared the survey results for 3 groups of adult patients: those receiving the RED program, those receiving a standard discharge on the same hospital unit, and those receiving a standard discharge on other hospital units. Results: A greater percentage of adult patients who received the RED discharge program rated the quality of their discharge as “very good” as compared to those receiving a standard discharge on the same hospital unit and those receiving a standard discharge on other hospital units (61%, 35%, and 41%, respectively, P = .0001). Conclusion: Delivery of a standardized hospital discharge program resulted in a larger proportion of top-box “very good” responses on a Press Ganey posthospitalization survey. Future research should examine whether hospital-based transition programs can sustain improvement in patient experience measures and whether these improvements can be observed in other patient populations.

School staff play a critical role in referring adolescents with serious emotional disturbance (SED) to mental health services; however, the mechanisms underlying this referral process are poorly understood. We used data from adolescents (N = 4365) enrolled in SAMHSA’s Children’s Mental Health Initiative Systems of Care (SOC) and participating in a national evaluation to compare the profiles of youth referred for SOC services by school staff with youth referred for those services by professionals at other agencies. We sought to identify whether school staff referred a unique set of adolescents by examining indicators of global impairment and impairment in school functioning (i.e., absences, suspensions, failures). Using multilevel regression models, we estimated the association of global impairment and school functioning with referral source (i.e., school vs. other) and controlled for SOC community characteristics and individual-level socio-demographics. Findings indicated that adolescents referred from schools had significantly lower levels of global impairment than adolescents referred from mental health settings. However, they had considerable school-related impairment, with rates of absences, suspensions, and failures that were equivalent to youth referred from most other agencies. This study is the first to examine school-related impairment among youth receiving SOC services as a function of referral source. By identifying adolescents with more mild global impairment, who nonetheless experienced significant impairment in school functioning, schools can be key contributors to effectively identifying a unique set of adolescents for SOC services. Further, schools might meaningfully inform the provision of comprehensive services to this population by educating community agencies about school functioning among youth with SED.

Effectively coordinating school and community services has remained an elusive goal for children’s mental health service providers. Researchers speculate that when community and school-based providers collaborate, supports for youth with serious emotional and behavioral disorders improve. An understudied corresponding hypothesis is that such improvement will be associated with successful school outcomes. Aims of this study included: (1) investigating outcomes of students referred by their schools to systems of care; (2) examining socio-demographic correlates of outcomes; and (3) comparing youth referred by schools to youth referred by mental health agencies. Using data from an ongoing examination of more than 170 federally-funded system of care communities, findings suggest that students referred to systems of care by schools improved on internalizing and externalizing symptoms, absence rates, and rates of school failure. Youth referred from schools also had significantly greater improvement in absence rates than those referred by mental health agencies. These findings suggest the importance of considering referral source in understanding treatment outcomes. In particular, results indicate that school staff might play an especially important role in referral to community systems of care, as their involvement in referral might facilitate improved school functioning outcomes.

Most pediatric acute myeloid leukemia (pAML) patients achieve complete remission after chemotherapy, yet relapse is common, with nearly 40% ultimately dying of the disease. Prognosis is currently assessed using cytogenetic biomarkers and measurable residual disease after the first chemotherapy cycle, with the highest risk patients referred for stem cell transplantation (SCT) at first remission. Because aggressive therapies such as SCT are highly toxic, yet cures after relapse are rare, accurate early risk prediction is essential for improving outcomes. To address this need, we analyzed paired diagnosis-relapse samples from 33 pAML patients at single-cell resolution and identified chemoresistant cell populations whose abundance at diagnosis significantly improved risk prediction. Incorporating the detection of these cell populations into our risk model revealed a previously unrecognized patient subgroup with a 5-year event-free survival rate below 40%. Although this subgroup represents only 20% of pAML cases, it accounted for half of the deaths among patients who do not receive SCT at first remission. Moreover, molecular characterization of these chemoresistant cell populations uncovered potential therapeutic targets and candidate interventions relevant to most high-risk patients, paving the way for more effective targeted treatments for high-risk pAML patients.