TY - JOUR
KW - FQHC
KW - Health centers
KW - patient centered medical home
KW - severe mental illness
AU - M. Kilany
AU - R. Wells
AU - J. P. Morrissey
AU - M. E. Domino
A1 - 
AB - To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina's Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting-whether FQHC, other group, or individual-consistently outperforms the others in providing medical home services to people with severe mental illness.
AD - American Institutes for Research, Washington, D.C., USA.; The University of Texas School of Public Health, Houston, USA.; Professor Emeritus, Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA.; Department of Health Policy and Management, The Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 1105B McGavran-Greenberg Hall, CB#7411, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA. domino@unc.edu.
BT - Administration and Policy in Mental Health
C5 - Financing & Sustainability; Healthcare Disparities; Medical Home
CY - United States
DO - 10.1007/s10488-020-01050-1
JF - Administration and Policy in Mental Health
LA - eng
M1 - Journal Article
N2 - To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina's Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting-whether FQHC, other group, or individual-consistently outperforms the others in providing medical home services to people with severe mental illness.
PP - United States
PY - 2020
SN - 1573-3289; 0894-587X
T1 - Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness?
T2 - Administration and Policy in Mental Health
TI - Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness?
U1 - Financing & Sustainability; Healthcare Disparities; Medical Home
U2 - 32424452
U3 - 10.1007/s10488-020-01050-1
VO - 1573-3289; 0894-587X
Y1 - 2020
Y2 - May 18
ER -