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认证社区行为健康诊所对患有严重精神疾病的非 Medicaid 患者医疗利用的影响。

Certified Community Behavioral Health Clinic Demonstration Impact on Health Care Utilization Among Non-Medicaid Patients with Severe Mental Illnesses.

机构信息

University of Rochester Medical Center, Rochester, New York, USA.

出版信息

Popul Health Manag. 2024 Jun;27(5):345-352. doi: 10.1089/pop.2024.0103. Epub 2024 Aug 12.

DOI:10.1089/pop.2024.0103
PMID:39133113
Abstract

In 2017, the Certified Community Behavioral Health Clinic (CCBHC) demonstration was implemented in New York State to redesign care delivery and financing for behavioral health services. Although CCBHC primarily targeted Medicaid patients, it was hypothesized that the clinic-level benefits of CCBHC were expected to impact even non-Medicaid patients treated in CCBHCs. To test this hypothesis, this study conducted a health insurance claims data analysis of non-Medicaid (ie, commercial and Medicare) patients with severe mental illnesses, comparing a cohort of CCBHC-treated patients with a propensity score-matched comparison cohort of patients treated by non-CCBHC clinics on rates of mental health service utilization, hospitalization, and emergency department (ED) visits. The data suggested CCBHC was associated with more than 10% increase in outpatient mental health service utilization by the patients' second year of CCBHC exposure, accompanied by similarly significant reductions in the rates of all-cause ED visits and non-psychiatric hospitalization. These findings suggest that for behavioral health clinics that serve a sufficiently large population of Medicaid, the impact of innovative clinical redesign attributable to CCBHC is likely to extend to all patients treated by them.

摘要

2017 年,纽约州实施了认证社区行为健康诊所(CCBHC)示范项目,旨在重新设计行为健康服务的提供和融资方式。尽管 CCBHC 主要针对医疗补助计划(Medicaid)患者,但有人假设 CCBHC 的诊所层面的效益预计将对在 CCBHC 接受治疗的非医疗补助计划患者产生影响。为了验证这一假设,本研究对患有严重精神疾病的非医疗补助计划(即商业保险和医疗保险)患者进行了健康保险理赔数据分析,比较了一组接受 CCBHC 治疗的患者与接受非 CCBHC 诊所治疗的患者的倾向评分匹配对照组,比较了两组患者的心理健康服务利用率、住院率和急诊部(ED)就诊率。数据表明,在 CCBHC 接触的第二年,CCBHC 使患者的门诊心理健康服务利用率增加了 10%以上,同时所有原因的 ED 就诊率和非精神病住院率也显著降低。这些发现表明,对于那些服务 Medicaid 计划患者人数足够多的行为健康诊所来说,由于 CCBHC 而进行的创新临床设计的影响可能会扩展到所有接受他们治疗的患者。

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