Table 2. Association Between TEAM UP and Health Care Utilization and Quality-of-Care–Sensitive Measures Among Medicaid Enrolleesa.
| Utilization category | Utilization, No. of visits/1000 patients/quarter | |||||
|---|---|---|---|---|---|---|
| TEAM UP FQHCs | Comparison FQHCs | Longitudinal change, difference (95% CI) | DID, marginal effect (95% CI) | |||
| Preperiod (n = 37 804) | Postperiod (n = 21 192) | Preperiod (n = 60 381) | Postperiod (n = 32 618) | |||
| Avoidable utilization | ||||||
| Inpatient admissions | 6.6 | 6.6 | 6.2 | 6.1 | −0.1 (−1.0 to 0.9) | 0.02 (−1.73 to 1.76) |
| With MH diagnosis | 2.4 | 3.2 | 1.8 | 2.3 | 0.6 (0.1 to 1.2) | 0.09 (−0.92 to 1.11) |
| Without MH diagnosis | 4.2 | 3.4 | 4.4 | 3.8 | −0.7 (−1.4 to 0.0) | −0.35 (−1.71 to 1.01) |
| ED visits | 116.6 | 119.9 | 130.8 | 123.0 | −3.6 (−8.1 to 1.0) | 11.18 (2.43 to 19.93) |
| With MH diagnosis | 8.9 | 8.9 | 8.0 | 6.7 | −0.8 (−2.5 to 0.9) | 1.74 (−0.52 to 4.01) |
| Without MH diagnosis | 107.7 | 111.0 | 122.8 | 116.3 | −2.7 (−6.9 to 1.4) | 9.45 (1.06 to 17.84) |
| Other utilization | ||||||
| Primary care total visits | 594.5 | 502.8 | 580.5 | 514.6 | −76.0 (−85.0 to −67.0) | −24.43 (−43.92 to −4.94) |
| With MH diagnosis | 31.9 | 27.4 | 30.9 | 23.1 | −6.5 (−8.6 to −4.4) | 4.35 (0.02 to 8.67) |
| Without MH diagnosis | 562.6 | 475.4 | 549.7 | 491.5 | −69.5 (−78.2 to −60.8) | −28.62 (−47.29 to −9.94) |
| MH service use | ||||||
| Any service | 1944.6 | 1906.2 | 1596.2 | 1497.0 | −72.2 (−157.4 to 13.0) | 54.86 (1.29 to 108.43) |
| Therapy | 1527.1 | 1532.9 | 1247.5 | 1150.2 | −54.2 (−129.6 to 21.1) | 110.70 (57.58 to 163.82) |
| Consultation | 240.8 | 219.6 | 192.5 | 213.3 | 4.7 (−12.9 to 22.2) | −43.81 (−54.18 to −33.43) |
| MH screening | 167.0 | 147.7 | 148.6 | 125.9 | −21.2 (−25.0 to −17.4) | 6.18 (−3.06 to 15.43) |
| MH testing | 9.6 | 6.0 | 7.7 | 7.6 | −1.4 (−3.2 to 0.3) | −3.18 (−4.65 to −1.71) |
| Psychotropic medications, % of patients | ||||||
| Any psychotropic medication use (>0% of days) | 5.6 | 5.9 | 4.0 | 4.6 | 0.6 (0.3 to 0.8) | −0.4 (−0.7 to −0.01) |
| Any stimulant medication use (>0% of days) | 3.4 | 3.6 | 2.2 | 2.8 | 0.5 (0.3 to 0.6) | −0.4 (−0.7 to −0.2) |
| Polypharmacy (≥2 psychotropic medications) | 1.6 | 1.7 | 0.9 | 1.3 | 0.3 (0.2 to 0.4) | −0.3 (−0.4 to −0.1) |
| Quality-of-care–sensitive follow-up measures, % of patients | ||||||
| Follow-up visit after MH ED visit (MH or self-harm diagnosis)b,c | 67.2 | 69.9 | 57.6 | 67.3 | 6.9 (−1.1 to 14.9) | −6.7 (−23.0 to 9.6) |
| Follow-up visit after MH hospitalization (MH diagnosis)b,d | 71.2 | 63.4 | 66.7 | 65.5 | −4.1 (−16.3 to 8.1) | −0.8 (−25.4 to 23.8) |
Abbreviations: DID, difference-in-differences; ED, emergency department; FQHC, federally qualified health center; MH, mental health; TEAM UP, Transforming and Expanding Access to Mental Health Care in Urban Pediatrics.
Preperiod and postperiod estimates represent the mean number of visits per 1000 patients per quarter in the preperiod (2014 to 2016 quarter 2) vs the postperiod (2016 quarter 3 to2017). Longitudinal changes are differences in the mean between preperiod and postperiod for the whole sample represented with 95% CI associated with the t test. The DID estimates represent the interaction term between TEAM UP status and postperiod status.
Refers to follow-up visit within 7 days of discharge (either outpatient or primary care visit with MH diagnosis).
The number of observations used in the analysis for follow-up visits after MH ED visit is 653 because the follow-up visits occurred conditional on having MH ED visits.
The number of observations used in the analysis for follow-up visits after MH hospitalization is 243 because the follow-up visits occurred conditional on having MH hospitalization.