Does Access to Patient Centered Medical Home reduce Racial and Ethnic Disparities in the care for Pediatric Major Depressive Disorders?

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Project Summary: Racial/ethnic disparities in mental health care for youth remain large and persistent despite national attention to disparity reduction. Youth from minority racial/ethnic groups are approximately one-third to one-half as likely to receive mental health care as white youth. Disparities exist not only in initial access to care, but also in service completion and quality. These disparities in care access and quality likely contribute to the greater persistence, severity, and disease burden of mental disorder among African Americans and Latinos in adulthood. Due to the severe shortage of child and adolescent psychiatrists, primary care settings have become the first point of contact and the treatment site for all children and adolescents with behavioral issues. The patient centered medical home (PCMH) has been demonstrated as a promising model to empower primary care providers to perform screening, treatment and monitoring for pediatric mental disorders. However, its implication for addressing disparities has not yet been directly assessed. The Goal of the proposed research is to examine whether access to PCMH with integrated behavioral services, achieved through either service colocation or telepsychiatry, could remedy disparities in the care for pediatric major depressive disorders (MDD). In collaboration with one of the largest Medicaid managed care plan in southeast Texas, with more than 400,000 pediatric enrollees, we will combine the most recent Medicaid claims data (2013-16) with provider characteristics and systematic factors such as practice setting, practice size, and geographic location. Service colocation will be ascertained based on Geocoding, and the use of telepsychiatry will be identified using the Current Procedural Terminology codes. Our aims are: I. To examine the impact of having a PCMH as the “usual care provider” on the identification of MDD and to assess its association with the racial/ethnic disparity in MDD diagnosis rate; II. To compare the likelihood of receiving MDD treatment between those MDD cases first diagnosed at a PCMH versus traditional primary care, and to assess its association with the racial/ethnic disparity in MDD treated rate; III. To compare the impact of initiating MDD treatment within a PCMH versus a traditional primary care setting on the treatment quality and outcomes and to assess its contribution to racial/ethnic disparity reduction. Guided by the Andersen/Aday health care access model, we will test the Hypothesis that accessing primary care with high structural quality (behavioral service integration present) can disproportionally benefit the minority groups and reduce racial/ethnic disparity in process quality (MDD identification, treated rates, and treatment quality), eventually leading to reduced racial/ethnic disparity in outcome quality (fewer emergency room visits and psychiatric hospital admissions). This innovative study is the first that concurrently examines the quality impact of service colocation and telepsychiatry and its relevance to racial/ethnic disparities in pediatric mental disorders. Findings will inform policy makers the effectiveness of the PCMH initiatives currently being implemented.