https://www.selleckchem.com/products/DMXAA(ASA404).html Skills and confidence in communicating during board meetings was higher after training (control marginal mean=5.11, intervention marginal mean=5.42, mean difference=0.31, 90% CI (-0.03 to 0.66), one-sided p=0.068, =0.40). Board meeting processes were also improved after training (control marginal mean=4.97, intervention marginal mean=5.37, mean difference=0.40, 90% CI (0.14 to 0.65), one-sided p=0.005, =0.54). Simulation-based training appeared to improve board members' skills and confidence, and perceptions of board meeting processes. A larger scale trial is needed to examine possible impacts on patient outcomes. Open Science Framework http//osf.io/jaxt6/; Pre-results. Open Science Framework http//osf.io/jaxt6/; Pre-results. Most of the literature on high-cost users of health care has evaluated this population as a whole, but few studies have focused on high-cost patients with mental illness and whether they persist in the high-cost state. We sought to analyze this patient population in depth and determine predictors of persistency in the high-cost state. We used 8 years of longitudinal patient-level population data (2010-2017) from Ontario to follow high-cost patients (those in and above the 90th percentile of the cost distribution) with mental illness. We classified high-cost status, based on the proportion of the study period that patients spent in the high-cost state, as persistent (6-8 yr), sporadic (1-2 yr) or moderate (3-5 yr). We compared characteristics between groups and determined predictors of being a patient with mental illness and persistent high-cost status. Among 52 638 patients with mental illness and high-cost status, 18 149 (34.5%) were considered persistent high cost. These patients had higher mean annuaith mental illness before they enter the persistent high-cost state, are needed. Among patients with mental illness and high-cost status, persistence in the high-cost state was determined ma