Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
PBHCI Program
Design
Participants
Intervention groups.
Comparison groups.
Clinic 1 (N=746) | Clinic 2 (N=778) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
PBHCI (N=373) | Comparison (N=373) | PBHCI (N=389) | Comparison (N=389) | |||||||
Characteristic | N | % | N | % | pb | N | % | N | % | pb |
Age (M±SD) | 47.60±11.12 | 47.55±13.15 | .96 | 46.95±10.18 | 47.00±11.31 | .93 | ||||
Male | 256 | 68 | 270 | 72 | .26 | 265 | 68 | 261 | 67 | .76 |
Race-ethnicity | .90 | .66 | ||||||||
American Indian/Alaska Native | 6 | 2 | 6 | 2 | 9 | 2 | 10 | 3 | ||
Asian | 18 | 5 | 20 | 5 | 12 | 3 | 10 | 3 | ||
Black | 137 | 37 | 152 | 41 | 110 | 28 | 124 | 32 | ||
Hispanic | 10 | 3 | 7 | 2 | 15 | 4 | 22 | 6 | ||
Multiracial | 9 | 2 | 11 | 3 | 6 | 2 | 5 | 1 | ||
Native Hawaiian/other Pacific Islander | 1 | <1 | 0 | — | 1 | <1 | 0 | 0 | ||
Other | 5 | 1 | 6 | 2 | 0 | — | 0 | — | ||
White | 184 | 49 | 168 | 45 | 229 | 59 | 208 | 53 | ||
Missing | 3 | 1 | 3 | 1 | 7 | 2 | 10 | 3 | ||
Primary language | .64 | .90 | ||||||||
English | 343 | 92 | 349 | 94 | 354 | 91 | 351 | 90 | ||
Other | 24 | 6 | 18 | 5 | 13 | 3 | 13 | 3 | ||
Missing | 6 | 2 | 6 | 2 | 22 | 6 | 25 | 6 | ||
Homeless | 118 | 32 | 114 | 31 | .75 | 256 | 66 | 270 | 69 | .28 |
Primary insurance | .80 | .35 | ||||||||
Commercial | 17 | 5 | 20 | 5 | 3 | 1 | 3 | 1 | ||
Medicaid | 186 | 50 | 175 | 47 | 194 | 50 | 190 | 49 | ||
Medicare | 132 | 38 | 145 | 39 | 146 | 38 | 138 | 35 | ||
Self-pay | 28 | 8 | 43 | 9 | 46 | 12 | 58 | 15 | ||
Preperiod utilization and costs PMPMc | ||||||||||
Outpatient | ||||||||||
Costs (M±SD $) | 189.42±233.31 | 194.28±301.06 | .81 | 32.76±80.34 | 31.46±74.22 | .82 | ||||
Visits (M±SD) | .56±.68 | .61±.85 | .43 | .09±.19 | .10±.24 | .51 | ||||
Inpatient | ||||||||||
Costs (M±SD $) | 326.30±952.75 | 329.00±1,625.39 | .98 | 466.48±1,394.38 | 494.64±2,965.84 | .87 | ||||
Admissions (M±SD) | .02±.06 | .02±.06 | .65 | .03±.06 | .03±.09 | .44 | ||||
Emergency department | ||||||||||
Costs (M±SD $) | 70.71±159.49 | 78.42±166.58 | .52 | 97.18±200.12 | 95.05±226.09 | .89 | ||||
Visits (M±SD) | .12±.21 | .11±.20 | .68 | .17±.33 | .16±.40 | .78 |
Data Sources
Data Analyses
Results
Clinic 1 (N=746) | Clinic 2 (N=778) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Illness | PBHCI (N=373) | Comparison (N=373) | PBHCI (N=389) | Comparison (N=389) | ||||||
N | % | N | % | pb | N | % | N | % | pb | |
Total (M±SD) | 5.31±2.85 | 4.45±3.73 | <.001 | 3.36±3.10 | 2.88±3.65 | .047 | ||||
AIDS/HIV | 4 | 1 | 11 | 3 | .07 | 2 | 1 | 2 | 1 | 1.00 |
Cancer | 22 | 6 | 13 | 3 | .12 | 7 | 2 | 9 | 2 | .61 |
Cardiovascular | 160 | 43 | 132 | 35 | .04 | 93 | 24 | 84 | 22 | .44 |
Central nervous system | 139 | 37 | 147 | 39 | .55 | 97 | 25 | 99 | 25 | .87 |
Cerebrovascular | 9 | 2 | 7 | 2 | .61 | 4 | 1 | 11 | 3 | .07 |
Developmental disability | 6 | 2 | 0 | — | .01 | 5 | 1 | 1 | <1 | .10 |
Diabetes | 62 | 17 | 58 | 16 | .69 | 27 | 7 | 20 | 5 | .29 |
Ear | 20 | 5 | 9 | 2 | .04 | 14 | 4 | 20 | 5 | .29 |
Eye | 55 | 15 | 55 | 15 | 1.00 | 16 | 4 | 20 | 5 | .49 |
Genital | 116 | 31 | 110 | 29 | .63 | 80 | 21 | 78 | 20 | .86 |
Gastrointestinal | 40 | 11 | 27 | 7 | .10 | 15 | 4 | 23 | 6 | .18 |
Hematological | 31 | 8 | 42 | 11 | .18 | 30 | 8 | 29 | 7 | .89 |
Infectious | 21 | 6 | 17 | 5 | .51 | 40 | 10 | 30 | 8 | .21 |
Metabolic | 187 | 50 | 136 | 36 | <.001 | 95 | 24 | 67 | 17 | .01 |
Pregnancy/perinatal | 1 | <1 | 4 | 1 | .18 | 3 | 1 | 3 | 1 | 1.00 |
Psychiatric, high | 214 | 57 | 81 | 22 | <.001 | 116 | 30 | 52 | 13 | <.001 |
Psychiatric, medium | 143 | 38 | 145 | 39 | .88 | 73 | 19 | 53 | 14 | .05 |
Psychiatric, low | 8 | 2 | 27 | 7 | <.001 | 24 | 6 | 32 | 8 | .27 |
Pulmonary | 127 | 34 | 112 | 30 | .24 | 110 | 28 | 102 | 26 | .52 |
Renal | 65 | 17 | 55 | 15 | .32 | 34 | 9 | 58 | 15 | .01 |
Skeletal | 172 | 46 | 160 | 43 | .38 | 135 | 35 | 109 | 28 | .04 |
Skin | 150 | 40 | 137 | 37 | .33 | 144 | 27 | 92 | 24 | <.001 |
Substance abuse | 229 | 61 | 174 | 47 | <.001 | 143 | 37 | 125 | 32 | .17 |
Clinic 1 (N=746) | Clinic 2 (N=778) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
PBHCI (N=373) | Comparison (N=373) | PBHCI (N=389) | Comparison (N=389) | |||||||||
Health care measure | Pre-period | Post-period | Pre-post difference | Pre-period | Post-period | Pre-post difference | Pre-period | Post-period | Pre-post difference | Pre-period | Post-period | Pre-post difference |
Outpatient general medical visits | ||||||||||||
Percentage of clients | 80 | 92 | 12 | 61 | 60 | –1 | 39 | 76 | 37 | 28 | 31 | 3 |
Visits PMPM | .56 | .56 | –.01 | .61 | .49 | –.11 | .09 | .18 | .09 | .08 | .12 | .04 |
Costs PMPM ($) | 189.42 | 230.78 | 41.36 | 194.28 | 172.64 | –21.64 | 32.76 | 69.86 | 37.10 | 27.82 | 50.58 | 22.76 |
Inpatient hospital admissions | ||||||||||||
Percentage of clients | 18 | 12 | –6 | 15 | 17 | 2 | 21 | 22 | 1 | 19 | 20 | 1 |
Admissions PMPM | .02 | .01 | –.01 | .02 | .02 | .00 | .03 | .02 | –.01 | .03 | .03 | –.00 |
Costs PMPM ($) | 326.30 | 281.94 | –44.36 | 329.00 | 479.39 | 150.39 | 466.48 | 439.44 | –27.05 | 418.75 | 470.28 | –51.53 |
Emergency department visits | ||||||||||||
Percentage of clients | 51 | 40 | –11 | 48 | 40 | –8 | 55 | 52 | –3 | 40 | 38 | –2 |
Visits PMPM | .12 | .09 | –.03 | .11 | .10 | –.01 | .17 | .15 | –.02 | .16 | .14 | –.03 |
Costs PMPM ($) | 70.71 | 61.96 | –8.74 | 78.42 | 86.28 | 7.86 | 97.18 | 83.91 | –13.21 | 109.04 | 99.12 | –4.08 |
Health care measure | Clinic 1 (N=746) | Clinic 2 (N=778) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Unadjusted difference | Adjusted DID | Unadjusted difference | Adjusted DID | |||||||||
PBHCI | Comparison | p | Estimate | 95% CI | p | PBHCI | Comparison | p | Estimate | 95% CI | p | |
Outpatient general medical visits | ||||||||||||
Percentage of clients | .11 | –.01 | <.001 | .12 | .04 to.21 | .003 | .37 | .03 | <.001 | .34 | .25 to .43 | <.001 |
Visits PMPM | –.01 | –.11 | .03 | .09 | –.04 to .24 | .17 | .08 | .04 | <.001 | .04 | –.004 to .08 | .07 |
Costs PMPM ($) | 41.36 | –21.64 | .01 | $50.56 | –6.32 to 107.45 | .08 | 37.10 | 22.76 | .11 | .36 | –21.31 to 22.02 | .97 |
Inpatient hospital admissions | ||||||||||||
Percentage of clients | –.05 | .02 | .03 | –.07 | –.14 to .00 | .04 | .01 | .01 | .94 | .002 | –.07 to .08 | .95 |
Admissions PMPM | –.01 | .001 | .03 | –.01 | –.01 to .00 | .08 | –.005 | –.003 | .81 | –.00 | –.01 to .01 | .99 |
Costs PMPM ($) | –44.36 | 150.39 | .08 | –217.68 | –443.55 to 8.17 | .06 | –27.05 | 51.53 | .99 | –56.03 | –153.54 to 259.25 | .71 |
Emergency department visits | ||||||||||||
Percentage of clients | –.11 | –.08 | .45 | –.03 | –.12 to .06 | .52 | –.03 | –.02 | .84 | –.01 | –.10 to .08 | .87 |
Visits PMPM | –.02 | –.01 | .29 | –.01 | –.04 to .02 | .49 | –.02 | –.03 | .86 | –.01 | –.06 to .05 | .77 |
Costs PMPM ($) | –8.74 | 7.86 | .19 | –17.17 | –48.28 to 13.94 | .28 | –13.27 | –4.08 | .28 | –23.20 | –58.99 to 12.54 | .20 |
Discussion
Conclusions
Acknowledgments
References
Information & Authors
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History
Authors
Competing Interests
Funding Information
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Citations
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