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Published Online: September 2011

Use of Administrative Data to Identify Potential Service Gaps for Individuals With Serious Mental Illness

Thomas E. Smith, M.D. [email protected], Anita Appel, L.C.S.W., Sheila A. Donahue, M.A., Susan M. Essock, Ph.D. [email protected], Carlos T. Jackson, Ph.D., Adam Karpati, M.D., Trish Marsik, Robert W. Myers, Ph.D., and Lily Tom, D.S.W.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 62, Number 9
https://doi.org/10.1176/ps.62.9.pss6209_1094
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Abstract

Objective:

The New York City Mental Health Care Monitoring Initiative uses Medicaid claims data to identify individuals with serious mental illness who are experiencing or at risk for gaps in services. In this study the authors assessed whether proposed service use algorithms accurately identified such individuals.

Methods:

A random sample of 500 individuals with serious mental illness was identified. Individuals belonged to specific high-need cohorts and met predefined claims-based criteria for potential service gaps. Clinical staff initiated reviews with prior service providers for 230 individuals.

Results:

Over a two-week period staff completed reviews for 188 cases (88%). In 66 cases (35%) the individual was fully engaged in care; 84 (45%) had a recent episode of disengagement that was appropriately addressed, and 38 (20%) were not receiving adequate services.

Conclusions:

The proposed service use algorithms successfully identified high-need individuals with serious mental illness at risk for gaps in services. (Psychiatric Services 62:1094–1097, 2011)

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Figure 1 Level of disruption of mental health services among 230 individuals, by service cohort

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Cover: Approaching Thunder Storm, by Martin Johnson Heade, 1859. Oil on canvas, 28 × 44 inches. Gift of Erving Wolf Foundation and Mr. and Mrs. Erving Wolf, 1975. The Metropolitan Museum of Art, New York. Image © The Metropolitan Museum of Art/Art Resource, New York.
Psychiatric Services
Volume 62 • Number 9 • September 2011
Pages: 1094 - 1097
PubMed: 21885591

History

Published in print: September 2011
Published online: 14 January 2015

Authors

Details

Thomas E. Smith, M.D. [email protected]
Dr. Smith and Dr. Essock are affiliated with the Department of Psychiatry, Columbia University, New York City, and the New York State Psychiatric Institute, 1051 Riverside Dr., Unit 100, New York, NY 10032 (e-mail: [email protected]).
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Anita Appel, L.C.S.W.
Ms. Appel is with the New York State Office of Mental Health, New York City, and Ms. Donahue and Dr. Myers are with the New York State Office of Mental Health, Albany.
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Sheila A. Donahue, M.A.
Ms. Appel is with the New York State Office of Mental Health, New York City, and Ms. Donahue and Dr. Myers are with the New York State Office of Mental Health, Albany.
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Susan M. Essock, Ph.D. [email protected]
Dr. Smith and Dr. Essock are affiliated with the Department of Psychiatry, Columbia University, New York City, and the New York State Psychiatric Institute, 1051 Riverside Dr., Unit 100, New York, NY 10032 (e-mail: [email protected]).
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Carlos T. Jackson, Ph.D.
Dr. Jackson is with Community Care of North Carolina, and Dr. Karpati, Ms. Marsik, and Dr. Tom are with the New York City Department of Health and Mental Hygiene, New York City.
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Adam Karpati, M.D.
Dr. Jackson is with Community Care of North Carolina, and Dr. Karpati, Ms. Marsik, and Dr. Tom are with the New York City Department of Health and Mental Hygiene, New York City.
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Trish Marsik
Dr. Jackson is with Community Care of North Carolina, and Dr. Karpati, Ms. Marsik, and Dr. Tom are with the New York City Department of Health and Mental Hygiene, New York City.
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Robert W. Myers, Ph.D.
Ms. Appel is with the New York State Office of Mental Health, New York City, and Ms. Donahue and Dr. Myers are with the New York State Office of Mental Health, Albany.
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Lily Tom, D.S.W.
Dr. Jackson is with Community Care of North Carolina, and Dr. Karpati, Ms. Marsik, and Dr. Tom are with the New York City Department of Health and Mental Hygiene, New York City.
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