Table 2. Association Between FQHC-Level Telehealth Availability and Visit Rates Among Patients With Mental Health Diagnoses.
| No. of person-months | Marginal effects | Adjusted coefficient for difference-in-differences (95% CI)a,b | P value | ||||
|---|---|---|---|---|---|---|---|
| High-telehealth FQHCc | Low-telehealth FQHCd | ||||||
| Pretelehealth expansion visitse | Posttelehealth expansion visitsf | Pretelehealth expansion visitse | Posttelehealth expansion visitsf | ||||
| Follow-up visit within 30 d of mental health emergency department visit, No./total No. (%)g | 5207 | 2097/2591 (80.9) | 667/810 (82.3) | 1052/1324 (79.5) | 339/482 (70.3) | 7.67 (2.11-13.23) | .007 |
| No. of visits per 100 patients per mo among patients with mental health diagnosish | |||||||
| Any mental health diagnosis | 143 205 | 88.8 | 51.3 | 138.1 | 37.2 | 2.07 (1.97-2.17) | <.001 |
| Depression diagnosis | 71 665 | 105.7 | 65.4 | 157.2 | 43.7 | 2.30 (2.15-2.46) | <.001 |
| Anxiety diagnosis | 69 723 | 102.2 | 62.6 | 161.3 | 43.8 | 2.19 (2.06-2.34) | <.001 |
| Posttraumatic stress disorder, stressor, and trauma disorders diagnosis | 55 129 | 106.9 | 68.1 | 276.8 | 76.7 | 2.23 (2.06-2.42) | <.001 |
| Bipolar and other mood disorders diagnosis | 32 574 | 109.9 | 75.9 | 232.4 | 70.9 | 1.83 (1.68-1.99) | <.001 |
Abbreviation: FQHC, federally qualified health center.
The difference-in-differences coefficient for the quality of care follow-up measure is from a linear probability model, where the coefficient is reported on an absolute percentage point scale; a value greater than 0 indicates that telehealth was associated with an increase in the measure. The difference-in-differences coefficients for number of visits are from negative binomial models, where coefficients are reported as a relative incidence rate ratio; a value greater than 1 indicates that telehealth was associated with an increase in the measure.
High telehealth group included patients with mental health diagnoses at FQHCs in which 50% or more of all visits to the FQHC in the posttelehealth expansion period were delivered via telehealth (mean [SD], 68.0% [13.9%]).
Low telehealth group included patients with mental health diagnoses at FQHCs in which less than 50% of all visits to the FQHC in the posttelehealth expansion period were delivered via telehealth (mean [SD], 25.7% [8.6%]).
Pretelehealth expansion period is March 2019 to February 2020.
Posttelehealth expansion period is April 2020 to March 2021.
The quality of care follow-up measure excludes the first 6 months of the COVID-19 pandemic due to the rolling, look-back nature of Healthcare Effectiveness Data and Information Set measure calculation. Denominators shown are larger in the pretelehealth vs posttelehealth expansion period due to having more observation time, and thus more person-months, in the pretelehealth expansion period.
Number of visit measures excludes March 2020. Number of visits for any mental health diagnosis includes any FQHC visit among patients with any of the mental health diagnoses listed in Table 1. Visits by subdiagnosis represent any FQHC visit among patients with those specific diagnoses (diagnoses are not mutually exclusive or exhaustive).