Table 1.
Pooled states | Principal investigators | Grant title | Research aims | Datasets | Outcome indicators | Key findings |
---|---|---|---|---|---|---|
CO-OR | Zerzan and Libby | Sedative hypnotic use by the mentally ill: A Medicaid prescription policy study | Develop a pooled, multi-state Medicaid dataset to study changes in health service utilization associated with policy implementation of sedative hypnotic access restriction policy types (preferred drug lists, prior authorization and cost sharing) in CO and OR | Medicaid |
Prescriptions of psychotropics, second generation antipsychotic (SGA) Prescription drug, service utilization, and expenditure Speed and duration of policy impact on sedative hypnotic and SGAprescription fills |
Quetiapine was the most frequent SGA in both states (40 % new starts), and for low-dose SGA new starts (55 % CO, 63 % OR). Females had an increased likelihood, and people diagnosed with schizophrenia or anxiety had a decreased likelihood of low-dose quetiapine initiation. Initiation of low-dose quetiapine as a proportion of all SGA initiation and or of quetiapine starts significantly decreased after off-label promotion ended in one state (OR). Cost sharing and Preferred Drug Lists were associated with decreased utilization, but quantity limits were not associated with significant change in prescription rates in both states |
CT-WA | Morrissey and Frisman | Community reentry of persons with severe mental illness released from state prison | Assess the impact of expedited Medicaid benefits restoration policies on service utilization and costs among persons with severe mental illness | Medicaid |
Mental health service (inpatient and outpatient) use Substance use Arrest and incarceration Cost |
Inmates with severe mental illness who received expedited Medicaid benefits were more likely to access mental health services and have shorter time without insurance coverage; no significant effects in criminal justice outcomes and costs |
GA-SC | Narasimhan and Druss | Clinical and policy implications of a statewide emergency telepsychiatry program | Evaluate the impact of a statewide telepsychiatry intervention in emergency departments on service utilization and costs |
Medicaid All-payor, health data warehouse |
Inpatient admission Outpatient follow-up Total cost |
Intervention state had low rates of inpatient admission, lower costs, and higher rates of outpatient follow-up than a matched control state |
NY-PA | Essock, Donahue and Stein | Evaluating the impact of clinical alerts generated from Medicaid claims data | Using Medicaid claims data to generate clinical flags predicting short-term risk of continued psychiatric hospitalizations | Medicaid |
Psychiatric hospitalization Outpatient service use Psychotropic prescription Cost of service |
Multiple recent hospitalizations significantly predicted high short-term risk of continued frequent hospitalizations, but absence of recent medication fills and absence of recent outpatient services did not |
NY-PA | Wisdom, Hoagwood, Finnerty and Stein | Quality improvement implementation in child mental health: A 2-state comparison | Evaluate the impact of a statewide continuous quality improvement initiative for psychotropic polypharmacy and the effects of prior authorization policies on antipsychotics psychotropic prescription among children and adolescents |
Medicaid Area Resource File |
Psychotropic polypharmacy Antipsychotics prescription |
Polypharmacy patterns were associated with bipolar disorder, older age, specialty mental health services; polypharmacy decreased following clinic participation in the continuous quality improvement initiative; prior authorization policies had a modest but statistically significant effect on decreased antipsychotic use in children aged 6–12 |