Behavioral Health Integration in Community Health Centers and Hospital Emergency Department Utilization

项目概要/摘要 行为健康障碍影响了很大一部分美国人口，但医疗保健系统未能 提供充分的行为健康护理服务。因此，许多患者寻求 由于缺乏方便或易于获得的替代方案或因为没有保险而前往急诊室（艾德） 或者保险不足2006年至2014年间，美国到艾德就诊的行为健康人次增加了44%， 尽管医院和付款人努力引导患者选择成本较低的替代品。 先前的研究表明，如果患者病情有所改善，可以避免大部分艾德就诊 获得初级保健。一个关键的渠道是社区卫生中心，提供初级保健 和一些行为健康护理，以医疗服务不足的人口近30万人。 四分之三的CHC患者要么是医疗补助接受者，要么没有保险。虽然CHC广泛 被认为是艾德的初级保健替代品，无论它们是否有效地预防行为 健康艾德访问是未知的。 初级保健和行为保健的整合越来越被视为一种有效的战略， 护理协调。虽然近90%的社区卫生中心提供一些行为健康服务， 对于行为健康的影响在不同的设施和不同的时间有很大的不同。我们打算利用这一点 为了了解ED是否以及在多大程度上起着行为保健的作用， 替代那些缺乏或难以获得社区卫生中心行为健康护理的患者。我们的目标是： 1.测量和描述CHC行为健康服务在不同市场和不同时间的分布。 2.确定社区卫生中心行为健康服务的更大整合程度， 减少艾德行为健康访问。 3.探索CHC行为健康整合对艾德行为健康访视的影响是否不同 支付者群体。 描述性分析将显示在社区卫生中心提供行为健康服务的趋势， 国家一级的数据来自卫生资源和服务管理局统一数据集， 2012-2018年期间的护理服务领域。使用计量经济学分析，我们将测试 解决所有患者和所有患者的艾德和CHC行为健康就诊之间关系的假设 在服务区一级的医疗弱势患者。研究结果将为减少艾德使用的努力提供信息 通过在社区卫生中心提供更多的行为健康服务，并提供证据表明， 行为健康和初级保健服务一体化的重要好处。

PROJECT SUMMARY/ABSTRACT Behavioral health disorders affect a large share of the U.S. population, yet the healthcare system fails to provide adequate access to behavioral health care services. Consequently, many patients seek the emergency department (ED) for lack of convenient or accessible alternatives or because they are uninsured or underinsured. Behavioral health visits to the ED increased 44% in the U.S. between 2006 and 2014, despite hospital and payer efforts to steer patients toward lower cost alternatives. Previous research shows that a substantial portion of ED visits could be avoided if patients had improved access to primary care. A key channel is Community Health Centers (CHCs), which deliver primary care and some behavioral health care to a medically underserved population of nearly 30 million individuals. Three-quarters of CHC patients are either Medicaid recipients or uninsured. While CHCs are widely considered to be a primary care alternative to the ED, whether they are effective in preventing behavioral health ED visits is not known. Integration of primary care and behavioral health care is increasingly viewed as an effective strategy for care coordination. While nearly 90% of CHCs provide some behavioral health services, the level of service for behavioral health varies substantially across facilities and over time. We propose to exploit this variation in order to understand whether and to what extent EDs function as a behavioral health care substitute for patients who lack or have poor access to behavioral health care in CHCs. Our aims are to: 1. Measure and describe the distribution of CHC behavioral health services across markets and over time. 2. Determine the extent to which greater integration of behavioral health services in CHCs leads to reduction in ED behavioral health visits. 3. Explore whether the impact of CHC behavioral health integration on ED behavioral health visits differs across payer groups. Descriptive analyses will demonstrate trends in the provision of behavioral health services in CHCs using national level data from the Health Resources and Services Administration Uniform Dataset across Primary Care Service Areas (PCSAs) over the period 2012-2018. Using econometric analyses, we will test hypotheses addressing the relationship between ED and CHC behavioral health visits by all patients and by medically vulnerable patients at the service area level. Results will inform efforts to reduce ED utilization through greater provision of behavioral health services in CHCs and also provide evidence on a potentially important benefit of integration of behavioral health and primary care services.