Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor).
Psychiatr Serv. 2023 Sep 1;74(9):911-920. doi: 10.1176/appi.ps.20220410. Epub 2023 Mar 14.
The Certified Community Behavioral Health Clinic (CCBHC) demonstration is designed to increase access to comprehensive ambulatory care and crisis services, which may reduce emergency department (ED) visits and hospitalizations. This study examined whether the demonstration had an impact on ED visits and hospitalizations in Missouri, Oklahoma, and Pennsylvania.
This difference-in-differences analysis used Medicaid claims data from 2015 to 2019 to examine service use during a 12-month baseline period and the first 24 months of the demonstration for beneficiaries who received care from CCBHCs and beneficiaries who received care from other behavioral health clinics in the same state, representing care as usual. Propensity score methods were used to develop treatment and comparison groups with similar characteristics.
In Pennsylvania and Oklahoma, beneficiaries who received care from CCBHCs had a statistically significant reduction in the average number of behavioral health ED visits, relative to the comparison group (13% and 11% reductions, respectively); no impact on ED visits in Missouri was observed. The demonstration was associated with a statistically significant reduction in all-cause hospitalizations in Oklahoma, when the analysis used a 2-year rather than a 1-year baseline period, and also in Pennsylvania, when hospitalizations were truncated at the 98th percentile to exclude beneficiaries with outlier hospitalization rates.
The CCBHC demonstration reduced behavioral health ED visits in two states, and the study also revealed some evidence of reductions in hospitalizations.
认证社区行为健康诊所（CCBHC）示范旨在增加综合门诊护理和危机服务的可及性，这可能会减少急诊部（ED）就诊次数和住院治疗。本研究检验了该示范在密苏里州、俄克拉荷马州和宾夕法尼亚州对 ED 就诊次数和住院治疗是否产生了影响。
本差异分析使用了 2015 年至 2019 年的医疗补助索赔数据，以检验在 12 个月基线期和示范的前 24 个月期间，接受 CCBHC 治疗的受益人和在同一州接受其他行为健康诊所治疗的受益人的服务使用情况，代表常规护理。采用倾向评分法为具有相似特征的治疗组和对照组制定了方案。
在宾夕法尼亚州和俄克拉荷马州，与对照组相比，接受 CCBHC 治疗的受益人的行为健康急诊就诊次数平均减少了统计学显著的幅度（分别减少了 13%和 11%）；在密苏里州，未观察到 ED 就诊次数的影响。当分析使用 2 年而不是 1 年的基线期时，该示范与俄克拉荷马州的全因住院治疗的统计学显著减少相关，并且在宾夕法尼亚州，当将住院治疗截断在第 98 百分位以排除住院率异常的受益人的情况下，也与统计学显著减少相关。
CCBHC 示范减少了两个州的行为健康 ED 就诊次数，并且研究还显示了一些住院治疗减少的证据。
