Hodgkin Dominic, Merrick Elizabeth L, Horgan Constance M, Garnick Deborah W, McLaughlin Thomas J
Schneider Institute for Health Policy, Heller School of Social Policy and Management, Brandeis University, MS 035, Waltham, MA 02454-9110, USA.
Health Serv Res. 2007 Feb;42(1 Pt 1):104-23. doi: 10.1111/j.1475-6773.2006.00609.x.
To measure how a change in gatekeeping model affects utilization of specialty mental health services.
DATA SOURCES/STUDY SETTING: Secondary data from health insurance claims for services during 1996-1999. The setting is a managed care organization that changed gatekeeping model in one of its divisions, from in-person evaluation to the use of a call-center.
We evaluate the impact of the change in gatekeeping model by comparing utilization during the 2 years before and 2 years after the change, both in the affected division and in another division where gatekeeping model did not change. The design is thus a controlled quasi-experimental one. Subjects were not randomized. Key dependent variables are whether each individual had any specialty mental health visits in a year; the number of visits; and the proportion of users exceeding eight visits in a year. Key explanatory variables include demographic variables and indicators for patient diagnoses and their intervention status (time-period, study group).
DATA COLLECTION/EXTRACTION METHODS: Claims data were aggregated to create analytic files with one record per member per year, with variables reporting demographic characteristics and mental health service use.
After controlling for secular trends at the other division, the division which changed gatekeeping model eventually experienced an increase in the proportion of enrollees receiving specialty mental health treatment, of 0.5 percentage point. Similarly, there was an increase of about 0.6 annual visits per user, concentrated at the low end of the distribution. These changes occurred only in the second year after the gatekeeping changes.
The results of this study suggest that the gatekeeping changes did lead to increases in utilization of mental health care, as hypothesized. At the same time, the magnitude of the increase in access and mean number of visits that we found was relatively modest. This suggests that while the change from face-to-face specialty gatekeeping to call-center intake does increase utilization, it is unlikely to overwhelm a system with new demand or create huge cost increases.
衡量守门模式的改变如何影响专科心理健康服务的利用率。
数据来源/研究背景：1996 - 1999年期间医疗保险服务索赔的二手数据。研究背景是一家管理式医疗组织，该组织在其一个部门改变了守门模式，从面对面评估改为使用呼叫中心。
我们通过比较守门模式改变前两年和改变后两年在受影响部门以及守门模式未改变的另一个部门的利用率，来评估守门模式改变的影响。因此，该设计是一种对照准实验设计。受试者未随机分组。关键因变量包括每个人在一年中是否有任何专科心理健康就诊；就诊次数；以及一年中就诊超过八次的用户比例。关键解释变量包括人口统计学变量以及患者诊断及其干预状态的指标（时间段、研究组）。
数据收集/提取方法：索赔数据被汇总以创建分析文件，每年每个成员有一条记录，变量报告人口统计学特征和心理健康服务使用情况。
在控制了另一个部门的长期趋势后，改变守门模式的部门最终接受专科心理健康治疗的参保者比例增加了0.5个百分点。同样，每个用户每年的就诊次数增加了约0.6次，集中在分布的低端。这些变化仅发生在守门模式改变后的第二年。
本研究结果表明，如假设的那样，守门模式的改变确实导致了心理健康护理利用率的提高。同时，我们发现的获得服务机会增加的幅度和平均就诊次数相对较小。这表明，虽然从面对面的专科守门模式转变为呼叫中心受理确实会提高利用率，但不太可能使系统因新需求而不堪重负或导致成本大幅增加。
