Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders
Abstract
Objective:
Methods:
Results:
Conclusions:
Highlights
Methods
Setting and Intervention
Study Period and Sample
Statistical Analysis
Primary and Secondary Outcomes
Exploratory Subgroup Analyses
Results
Study Sample
Control group | Behavioral health home | |||||
---|---|---|---|---|---|---|
(N=1,929) | (N=413) | |||||
Characteristic | N | % | N | % | p | |
Age (M±SD) | 50.03±.39 | 50.74±.70 | .42 | |||
Female | 1,036 | 53.71 | 186 | 45.04 | <.01 | |
Native English speaker | 1,547 | 80.20 | 374 | 90.56 | <.01 | |
Diabetes | 344 | 17.83 | 78 | 18.89 | .62 | |
Primary psychotic disorder | 979 | 50.75 | 355 | 85.96 | <.01 | |
Bipolar disorder | 1,182 | 61.28 | 128 | 30.99 | <.01 | |
Race-ethnicity | ||||||
Asian | 70 | 3.63 | 18 | 4.36 | .48 | |
Hispanic | 168 | 8.71 | 6 | 1.94 | <.01 | |
Non-Hispanic Black | 302 | 15.66 | 95 | 23.00 | <.01 | |
Non-Hispanic White | 1,183 | 61.33 | 262 | 63.44 | .42 | |
Portuguese or Brazilian | 158 | 8.19 | 20 | 4.84 | .02 | |
Health insurance | ||||||
Medicaid | 1,027 | 53.24 | 181 | 43.83 | <.01 | |
Medicare | 737 | 38.21 | 209 | 50.61 | <.01 | |
Private | 156 | 8.09 | 23 | 5.57 | .08 | |
Self-pay | 8 | .41 | 0 | .19 | ||
Marital status | ||||||
Divorced | 216 | 11.20 | 33 | 7.99 | .05 | |
Legally separated | 67 | 3.47 | 5 | 1.21 | .02 | |
Married | 289 | 14.98 | 37 | 8.96 | <.01 | |
Single | 1,263 | 65.47 | 329 | 79.66 | <.01 | |
Widowed | 78 | 4.04 | 9 | 2.18 | .07 | |
Area-level indicators (M±SD %) | ||||||
Female-headed households | 14.62±.19 | 14.85±.37 | .60 | |||
Less than a high school education | 13.75±.22 | 10.21±.38 | <.01 | |||
Foreign born | 30.66±.26 | 27.97±.51 | <.01 | |||
Living in poverty | 13.87±.15 | 13.43±.30 | .23 |
![](/cms/10.1176/appi.ps.202000589/asset/images/large/appi.ps.202000589f1.jpeg)
Service Utilization DID
![](/cms/10.1176/appi.ps.202000589/asset/images/large/appi.ps.202000589f2.jpeg)
Pre-post intervention group shifts | Difference-in-difference shifts | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
(for contextualization) | (primary outcomes)b | |||||||||||
BHH level shift | BHH trend shift | Control level shift | Control trend shift | Level shift | Trend shift | |||||||
Visit type | Value | SE | Value | SE | Value | SE | Value | SE | Value | SE | Value | SE |
Primary care | .20** | −.03 | .008 | −.005 | .004 | −.03 | .0003 | −.004 | .18** | −.04 | .006 | −.004 |
ED | −.03* | −.01 | −.00009 | −.002 | .003 | −.008 | .0004 | −.001 | −.03* | −.01 | −.0002 | −.002 |
GMH inpatient | .006 | −.005 | .0007 | −.0006 | .004 | −.003 | −.00003 | −.0003 | .002 | −.003 | .0007** | −.0002 |
GMH outpatient | .06** | −.01 | .005** | −.001 | −.01 | −.01 | −.002 | −.001 | .06** | −.01 | .004** | −.001 |
Behavioral health inpatient | −.01 | −.008 | −.0003 | −.0009 | −.03** | −.004 | −.001** | −.0005 | .02* | −.008 | .001 | −.0008 |
Behavioral health outpatient | −.03 | −.05 | −.03** | −.005 | −.09* | −.04 | −.009** | −.003 | .07 | −.05 | −.02** | −.004 |
Subgroup Analyses
Cardiometabolic Measures
Discussion
Study Strengths
Study Limitations
Conclusions
Footnote
Supplementary Material
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