Treatment of major depression before and after implementation of a behavioral health carve-out plan.
Treatment of major depression before and after implementation of a behavioral health carve-out plan.
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实施行为健康剥离计划之前和之后重度抑郁症的治疗。
DOI：
10.1176/ps.49.12.1563
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Merrick,EL
中科院分区：
文献类型：
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作者：
Merrick,EL
本研究调查了1993年实施行为健康保健分割计划前后重度抑郁症治疗的利用、支付和质量指标，该计划针对的是通过赔偿计划或首选提供者组织获得医疗保险的马萨诸塞州雇员。541人在1992至1995财政年度连续参加优先提供者组织或赔偿计划。一个子样本的243用户的住院服务占352入院。采用双变量检验来比较创业计划实施前后的利用率和质量指标。简单比较本年度的美元被使用。在创业计划下，申请治疗重度抑郁症的注册者比例显着增加。住院病人的利用率大幅下降，主要是由于平均住院时间大幅缩短（实施分拆计划前为16天，实施分拆计划后为9天）。住院病人的净支付总额下降了71%，每次住院下降了65%，每天下降了40%。在15和30天内再次入院的因重度抑郁症治疗的出院患者的未调整比例没有显著变化。在这些时间框架内接受随访的病例的未调整比例显着增加。CONCLUSIONSSImplementation的行为健康分割计划的实施可能伴随着住院病人的利用率和治疗重度抑郁症的支付大幅减少。描述性研究结果表明，这种减少可能不会对30天内的再入院率和随访治疗率产生不利影响。然而，该分析没有控制患者特征，使用短随访期，并且不包括一些相关的结局指标。
OBJECTIVEThe study examined utilization, payments, and quality indicators for treatment of major depressive disorder before and after the 1993 implementation of a behavioral health care carve-out plan for Massachusetts state employees who received medical coverage through indemnity plans or preferred provider organizations.METHODSThe sample of 2,259 enrollees with claims for treatment of major depressive disorder was drawn from the group of 39,541 persons continuously enrolled in preferred provider organizations or indemnity plans for fiscal years 1992 to 1995. A subsample of 243 users of inpatient services accounted for 352 admissions. Bivariate tests were used to compare utilization and quality indicators before and after implementation of the carve-out plan. Simple comparisons of current-year dollars were used.RESULTSThe proportion of enrollees with claims for treatment of major depressive disorder increased significantly under the carve-out plan. Inpatient utilization decreased substantially, mostly due to a significantly lower average length of stay (16 days before implementation of the carve-out plan and nine days after). Net inpatient payments fell 71 percent overall, 65 percent per admission, and 40 percent per day. The unadjusted proportion of discharged patients treated for major depressive disorder who were readmitted within 15 and 30 days did not change significantly. The unadjusted proportion of cases receiving follow-up within those time frames increased significantly.CONCLUSIONSImplementation of a behavioral health carve-out plan may be accompanied by substantial reductions in inpatient utilization and payments for treatment of major depressive disorder. Descriptive findings suggest that such reductions may not have a detrimental impact on readmission and follow-up treatment rates within 30 days. However, this analysis did not control for patient characteristics, used short follow-up periods, and did not include some relevant outcome measures.