PDF(Pubmed)
Abstract：
BACKGROUND: Federally Qualified Health Centers (FQHCs) are a critical source of care for medically underserved populations and often serve as medical homes for individuals with serious mental illness (SMI). Many FQHCs provide mental health services and could facilitate access to mental health treatment within and outside of FQHCs. This study compared mental health care utilization and acute care events for adult Medicaid enrollees with SMI who receive care at Federally Qualified Health Centers (FQHCs) vs. other settings.
METHODS: This study used the 2015-2016 Massachusetts All-Payer Claims Database to examine outpatient mental health care and acute care events for 32,330 Medicaid adults, ages 18-64 and with major depressive, bipolar, or schizophrenia spectrum disorders (SSD), who resided in FQHC service areas and received care from FQHCs vs. other settings in 2015. Multivariable linear regressions assessed associations between receiving care at FQHCs and outpatient mental health visits, psychotropic medication fills, and acute care events in 2016.
RESULTS: There were 8,887 (27.5%) adults in the study population (N = 32,330) who had at least one FQHC visit in 2015. Those who received care at FQHCs were more likely to have outpatient mental health visits (73.3% vs. 71.2%) and psychotropic medication fills (73.2% vs. 69.0%, both p < .05), including antidepressants among those with depressive disorders and antipsychotics among those with SSD. They were more likely to have ED visits (74.0% vs. 68.7%), but less likely to be hospitalized (27.8% vs. 31.9%, both p < .05). However, there was no significant difference in the likelihood of having an acute psychiatric hospitalization (9.5% vs. 9.8%, p = .35).
CONCLUSIONS: Among Medicaid enrollees with SMIs who had access to care at FQHCs, those receiving care at FQHCs were more likely to have outpatient mental health visits and psychotropic medication fills, with lower rates of hospitalization, suggesting potentially improved quality of outpatient care. Higher ED visit rates among those receiving care at FQHCs warrant additional investigation.
METHODS: This study used the 2015-2016 Massachusetts All-Payer Claims Database to examine outpatient mental health care and acute care events for 32,330 Medicaid adults, ages 18-64 and with major depressive, bipolar, or schizophrenia spectrum disorders (SSD), who resided in FQHC service areas and received care from FQHCs vs. other settings in 2015. Multivariable linear regressions assessed associations between receiving care at FQHCs and outpatient mental health visits, psychotropic medication fills, and acute care events in 2016.
RESULTS: There were 8,887 (27.5%) adults in the study population (N = 32,330) who had at least one FQHC visit in 2015. Those who received care at FQHCs were more likely to have outpatient mental health visits (73.3% vs. 71.2%) and psychotropic medication fills (73.2% vs. 69.0%, both p < .05), including antidepressants among those with depressive disorders and antipsychotics among those with SSD. They were more likely to have ED visits (74.0% vs. 68.7%), but less likely to be hospitalized (27.8% vs. 31.9%, both p < .05). However, there was no significant difference in the likelihood of having an acute psychiatric hospitalization (9.5% vs. 9.8%, p = .35).
CONCLUSIONS: Among Medicaid enrollees with SMIs who had access to care at FQHCs, those receiving care at FQHCs were more likely to have outpatient mental health visits and psychotropic medication fills, with lower rates of hospitalization, suggesting potentially improved quality of outpatient care. Higher ED visit rates among those receiving care at FQHCs warrant additional investigation.
摘要：
背景：联邦合格健康中心（FQHC）是医疗服务不足人群的重要护理来源，通常是严重精神疾病（SMI）患者的医疗之家。许多FQHC提供心理健康服务，可以促进FQHC内外的心理健康治疗。这项研究比较了在联邦合格健康中心（FQHCs）接受护理的成人医疗补助参与者与SMI的精神健康护理利用和急性护理事件其他设置。
方法：本研究使用2015-2016年马萨诸塞州所有付款人索赔数据库来检查32,330名医疗补助成年人的门诊精神保健和急性护理事件，年龄在18-64岁，患有严重抑郁，双极,或精神分裂症谱系障碍（SSD），居住在FQHC服务区域并接受FQHC护理的人与2015年的其他设置。多变量线性回归评估了在FQHC接受护理和门诊心理健康就诊之间的关联，精神药物填充，和2016年的急性护理事件。
结果：研究人群（N=32,330）中有8,887（27.5％）名成年人在2015年至少进行了一次FQHC访问。在FQHC接受护理的人更有可能进行门诊精神健康就诊（73.3％vs.71.2%)和精神药物填充(73.2%vs.69.0%,两者p<.05)，包括抑郁症患者的抗抑郁药和SSD患者的抗精神病药。他们更有可能进行ED访问(74.0%vs.68.7%），但住院的可能性较小(27.8%vs.31.9%,两者均p<.05）。然而,急性精神病住院的可能性没有显着差异（9.5％与9.8%,p=.35）。
结论：在获得FQHC护理的SMI医疗补助注册者中，那些在FQHC接受护理的人更有可能进行门诊精神健康就诊和精神药物填充，住院率较低，提示可能改善门诊护理质量。在FQHCs接受护理的患者中，较高的ED就诊率值得进一步调查。
方法：本研究使用2015-2016年马萨诸塞州所有付款人索赔数据库来检查32,330名医疗补助成年人的门诊精神保健和急性护理事件，年龄在18-64岁，患有严重抑郁，双极,或精神分裂症谱系障碍（SSD），居住在FQHC服务区域并接受FQHC护理的人与2015年的其他设置。多变量线性回归评估了在FQHC接受护理和门诊心理健康就诊之间的关联，精神药物填充，和2016年的急性护理事件。
结果：研究人群（N=32,330）中有8,887（27.5％）名成年人在2015年至少进行了一次FQHC访问。在FQHC接受护理的人更有可能进行门诊精神健康就诊（73.3％vs.71.2%)和精神药物填充(73.2%vs.69.0%,两者p<.05)，包括抑郁症患者的抗抑郁药和SSD患者的抗精神病药。他们更有可能进行ED访问(74.0%vs.68.7%），但住院的可能性较小(27.8%vs.31.9%,两者均p<.05）。然而,急性精神病住院的可能性没有显着差异（9.5％与9.8%,p=.35）。
结论：在获得FQHC护理的SMI医疗补助注册者中，那些在FQHC接受护理的人更有可能进行门诊精神健康就诊和精神药物填充，住院率较低，提示可能改善门诊护理质量。在FQHCs接受护理的患者中，较高的ED就诊率值得进一步调查。
