Joshua Breslau1, Emily Leckman-Westin2, Bing Han3, Riti Pritam4, Diana Guarasi5, Marcela Horvitz-Lennon6, Deborah M Scharf7, Molly T Finnerty8, Hao Yu9. 1. RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA. Electronic address: jbreslau@rand.org. 2. New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA. Electronic address: Emily.Leckman-Westin@omh.ny.gov. 3. RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA. Electronic address: bhan@rand.org. 4. New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA. Electronic address: Riti.Pritam@omh.ny.gov. 5. New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA. Electronic address: Diana.Guarasi@omh.ny.gov. 6. RAND Corporation, 20 Park Plaza # 920, Boston, MA 02116, USA. Electronic address: horvitz@rand.org. 7. Lakehead University, Faculty of Education, 500 University Avenue, Orillia, ON L3V 0B9, Canada. 8. New York University, Langone Medical Center, New York, NY 10016, USA. Electronic address: Molly.Finnerty@omh.ny.gov. 9. RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA. Electronic address: haoyu@rand.org.
Abstract
OBJECTIVE: Integrating primary care services into specialty mental health clinics has been proposed as a method for improving health care utilization for medical conditions by adults with serious mental illness. This paper examines the impact of a mental health based primary care program on emergency department (ED) visits and hospitalizations. METHOD: The program was implemented in seven New York City outpatient mental health clinics in two waves. Medicaid claims were used to identify patients treated in intervention clinics and a control group of patients treated in otherwise similar clinics in New York City. Impacts of the program were estimated using propensity score adjusted difference-in-differences models on a longitudinally followed cohort. RESULTS: Hospital stays for medical conditions increased significantly in intervention clinics relative to control clinics in both waves (ORs = 1.21 (Wave 1) and 1.33 (Wave 2)). ED visits for behavioral health conditions decreased significantly relative to controls in Wave 1 (OR = 0.89), but not in Wave 2. No other significant differences in utilization trends between the intervention and control clinics were found. CONCLUSION: Introducing primary care services into mental health clinics may increase utilization of inpatient services, perhaps due to newly identified unmet medical need in this population.
OBJECTIVE: Integrating primary care services into specialty mental health clinics has been proposed as a method for improving health care utilization for medical conditions by adults with serious mental illness. This paper examines the impact of a mental health based primary care program on emergency department (ED) visits and hospitalizations. METHOD: The program was implemented in seven New York City outpatient mental health clinics in two waves. Medicaid claims were used to identify patients treated in intervention clinics and a control group of patients treated in otherwise similar clinics in New York City. Impacts of the program were estimated using propensity score adjusted difference-in-differences models on a longitudinally followed cohort. RESULTS: Hospital stays for medical conditions increased significantly in intervention clinics relative to control clinics in both waves (ORs = 1.21 (Wave 1) and 1.33 (Wave 2)). ED visits for behavioral health conditions decreased significantly relative to controls in Wave 1 (OR = 0.89), but not in Wave 2. No other significant differences in utilization trends between the intervention and control clinics were found. CONCLUSION: Introducing primary care services into mental health clinics may increase utilization of inpatient services, perhaps due to newly identified unmet medical need in this population.
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