Literature Collection

INTRODUCTION: Depressive disorders in adolescents are highly prevalent and debilitating and are a risk factor for self-harm and death by suicide. In the context of recovery from the COVID-19 pandemic, strained healthcare resources are compounded by an increased demand for treatment services for adolescents with depression. The objective of this study protocol is to delineate the proposed economic evaluation of an integrated care pathway for depression in adolescents within the Care for Adolescents who Received Information 'Bout Outcomes, 2nd iteration (CARIBOU-2) non-randomised, cluster-controlled trial. METHODS AND ANALYSIS: Two economic evaluations of the CARIBOU-2 trial (n=300) will be conducted-a cost-effectiveness analysis and a cost-utility analysis. In the cost-effectiveness analysis, we will examine the primary clinical outcome of the trial, change in the Mood and Feelings Questionnaire total score. In the cost-utility analysis, the clinical outcome will be quality-adjusted life-years, a generic measure of health burden. Data on the resources and respective costs required to deliver the intervention will be collected by the research team. Data on resource use post-intervention will be obtained from a mix of administrative data holdings and self-report; relevant unit costs will be obtained from existing data sources. The outcome of both economic evaluations will be the incremental cost-effectiveness ratio. Relevant sensitivity analyses will be undertaken, and cost-effectiveness acceptability curves will be produced to characterise any sources of uncertainty in the analysis. Equity considerations will also be examined, where relevant. ETHICS AND DISSEMINATION: Ethical approval for the larger CARIBOU-2 trial, including the economic evaluation, has been obtained by the Centre for Addiction and Mental Health as well as site-level ethics boards (019/2021; Centre for Addiction and Mental Health). All participants will provide informed consent for their data to be analysed and reported. The results of the main trial and the economic evaluation will be submitted for publication in a peer-reviewed journal and shared with relevant policy makers across Canada. TRIAL REGISTRATION NUMBER: NCT05142683.

OBJECTIVE: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians. METHODS: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. RESULTS: Overall, 10,294 CoCM and general BHI services were delivered in 2017, totaling $626,292 in payments, and 81,433 CoCM and general BHI services were delivered in 2018, totaling $7,442,985 in payments. Medicare denied 5% of services in 2017 and 32% in 2018. Most CoCM and general BHI services were delivered by primary care physicians in office-based settings. CONCLUSIONS: This study of codes designed to promote BHI revealed an eightfold increase in CoCM and general BHI use between 2017 and 2018. However, denied services represent a barrier, and use among eligible beneficiaries remains low.

BACKGROUND: The Veterans Health Administration (VHA) greatly expanded the proportion of health care services it purchases from community providers over the last decade, which could impact the quality of care and create care fragmentation. Continuity of care between inpatient and outpatient care delivery systems is critical for high-quality mental health care. OBJECTIVE: To compare rates of outpatient follow-up visits between VHA-purchased and VHA-delivered psychiatric hospitalizations, overall and by VHA facility. METHODS: Using VHA electronic medical records and community care claims data, we compared 7-day and 30-day outpatient follow-up rates across VHA-purchased and VHA-delivered settings. We estimated follow-up rates and comparisons overall as well as separately for 4 diagnosis groups and separately across VHA facilities. RESULTS: Our sample included 64,784 hospitalizations; more than 30% were VHA-purchased as opposed to VHA-delivered. Compared with VHA-delivered hospitalizations, follow-up rates were 30.1 (95% CI: 27.8-32.5) percentage points lower at 7 days and 22.5 (95% CI: 20.8-24.1) percentage points lower at 30 days for VHA-purchased hospitalizations. Lower follow-up rates occurred for neurocognitive disorder discharges for both VHA-purchased and delivered care. Follow-up rates at 30 days were significantly lower for VHA-purchased hospitalizations at 121 out of 128 facilities and significantly higher at no facility. CONCLUSIONS: VHA enrollees seeking mental health care and VHA program managers could benefit from data on psychiatric care quality differences between community providers and VHA providers. From a system perspective, VHA-purchased care quality reports and value-based purchasing contracts could include outpatient follow-up quality measures to incentivize higher quality care.