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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 26 Research Studies Displayed
McBain RK, Cantor JH, Kofner A
Brief report: Medicaid expansion and growth in the workforce for autism spectrum disorder.
This study examined the role that state Medicaid expansion has played in utilization of child psychiatrists, board-certified behavioral analysts (BCBAs) and pediatricians for children with autism spectrum disorder (ASD). Health workforce data from HRSA was used to examine workforce growth from 2008-2017. State Medicaid expansion was associated with a 9% increase in BCBAs per 100,000 children one year after enactment, and a 5% increase in child psychiatrists, but no association with growth in pediatrician utilization.
Citation: McBain RK, Cantor JH, Kofner A . Brief report: Medicaid expansion and growth in the workforce for autism spectrum disorder. J Autism Dev Disord 2022 Apr;52(4):1881-89. doi: 10.1007/s10803-021-05044-2..
Keywords: Children/Adolescents, Autism, Medicaid, Workforce, Behavioral Health
Auty SG, Griffith KN
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. Using data from the CDC’s WONDER database, findings showed that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
Citation: Auty SG, Griffith KN . Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2022 Mar 1;232:109340. doi: 10.1016/j.drugalcdep.2022.109340..
Keywords: COVID-19, Medicaid, Opioids, Substance Abuse, Behavioral Health, Mortality, Public Health
Caves Sivaraman JJ, Ranapurwala SI, Proescholdbell S
Suicide typologies among Medicaid beneficiaries, North Carolina 2014-2017.
Only ½ of suicide decedents are diagnosed with a mental health condition; population-based screening strategies are needed to help identify people who are at risk of suicide, and it may be necessary for providers to consider patient life circumstances that may place them at a higher risk. The purpose of this study was to identify suicide typologies among suicide decedents and describe the alignment between medical diagnoses and life circumstances. Decedent demographics, stressful life events, perceived and diagnosed/ health issues, suicidal behavior, and suicide method contributed to the typologies. In 2020 the researchers linked North Carolina Medicaid data with data from the North Carolina Violent Death reporting System (NC-VDRS) to analyze suicide decedents from 2014-2017, aged 25-54 years of age. Researchers analyzed 6 indicators of life circumstances from Medicaid claims and 12 indicators from the NC-VDRS and developed separate models for men and women. The study found that 88.3% of the suicide decedents were White, with a median age of 41 years, and more than 70% had experienced a health care visit in the 90 days prior to suicide. The study concluded that almost one-half of suicide decedents have a typology characterized by a low probability of diagnosis of mental health issues. The authors report that screenings for suicide could be improved by using improved indicators of lived experience and mental health.
Citation: Caves Sivaraman JJ, Ranapurwala SI, Proescholdbell S . Suicide typologies among Medicaid beneficiaries, North Carolina 2014-2017. BMC Psychiatry 2022 Feb 10;22(1):104. doi: 10.1186/s12888-022-03741-5..
Keywords: Medicaid, Behavioral Health
McClellan C, Maclean JC, Saloner B
AHRQ Author: McClellan C
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
This study provided the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. As of 2016, 16 states had adopted an HH for enrollees with serious mental illness and/or substance use disorder. Using data from the National Survey on Drug Use and Health, the authors found that HH adoption increased service use among enrollees and enrollee self-reported health improved post-HH.
Citation: McClellan C, Maclean JC, Saloner B . Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes. Health Econ 2020 Sep;29(9):1086-97. doi: 10.1002/hec.4027..
Keywords: Behavioral Health, Medicaid, Substance Abuse, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Zuvekas SH, McClellan CB, Ali MM
AHRQ Author: Zuvekas SH, McClellan CB
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
Citation: Zuvekas SH, McClellan CB, Ali MM . Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition. J Ment Health Policy Econ 2020 Sep 1;23(3):151-82..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Medicaid, Health Insurance, Access to Care, Healthcare Utilization, Policy, Uninsured
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
Citation: Mackie TI, Cook S, Crystal S . Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention. J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Liu X, Shah V, Kubilis P
Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD.
This study analyzed the use of psychotropic treatments in children with concomitant ADHD and oppositional defiant disorder/conduct disorder (ODD/CD). The data from a cross-sectional drug utilization study based on Medicaid fee-for-service programs in 26 U.S. states from 1999 to 2006. Children ages 4 to 18 were included, with a total of 121,740 children identified. There was a period prevalence of 38.1% for “no psychotropic therapy”, 44.7% for psychotropic monotherapy, and 9% for psychotropic dual therapy. Stimulants were the most common drug class prescribed. Psychotropic combination therapy was used most with whites, males, and children in foster care.
Citation: Liu X, Shah V, Kubilis P . Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD. J Atten Disord 2019 Jan;23(2):140-48. doi: 10.1177/1087054715596574..
Keywords: Children/Adolescents, Behavioral Health, Medicaid, Medication
Fry CE, Sommers BD
Effect of Medicaid expansion on health insurance coverage and access to care among adults with depression.
This quasi-experimental study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression. The investigators found that Medicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance. Medicaid expansion was also associated with significant reductions in delaying care and medications because of cost.
Citation: Fry CE, Sommers BD . Effect of Medicaid expansion on health insurance coverage and access to care among adults with depression. Psychiatr Serv 2018 Nov;69(11):1146-52. doi: 10.1176/appi.ps.201800181..
Keywords: Access to Care, Depression, Health Insurance, Medicaid, Behavioral Health
Moulin A, Evans EJ, Xing G
Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
The objective of this study was to identify characteristics unique to patients with psychiatric illness who are frequent emergency department (ED) users for mental health care. The authors suggest that understanding unique features of this population could lead to better care and lower healthcare costs. The authors concluded that patients with substance use disorders, homelessness and public healthcare coverage were more likely to be frequent users of EDs for mental illness.
Citation: Moulin A, Evans EJ, Xing G . Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization. West J Emerg Med 2018 Nov;19(6):902-06. doi: 10.5811/westjem.2018.9.38954..
Keywords: Emergency Department, Medicaid, Healthcare Utilization, Behavioral Health, Substance Abuse, Vulnerable Populations
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
Citation: Andrews CM, Grogan CM, Smith BT . Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act. Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Yucel A, Essien EJ, Sanyal S
Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the Medicaid program.
The purpose of this study was to examine whether racial/ethnic differences in receipt of major depressive disorder (MDD) treatment could be explained by the specialty of provider diagnosing the adolescent. The investigators found that for adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.
Citation: Yucel A, Essien EJ, Sanyal S . Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the Medicaid program. J Affect Disord 2018 Aug 1;235:155-61. doi: 10.1016/j.jad.2018.04.045..
Keywords: Access to Care, Depression, Disparities, Medicaid, Behavioral Health, Racial / Ethnic Minorities
Olfson M, Wall M, Wang S
Suicide after deliberate self-harm in adolescents and young adults.
This study’s objective was to identify risk factors for repeated nonfatal self-harm and suicide death among adolescents and young adults, using a national cohort of patients in the Medicaid program who were followed for up to 1 year after initial self-harm. Data on cause of death was obtained from the National Death Index. The results of the study indicated that adolescents and young adults showed a markedly elevated risk of suicide after nonfatal self-harm. The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents than young adults. Hazards of suicide after self-harm were also higher for American Indians and Alaskan natives than for non-Hispanic white patients and for those self-harm patients who initially used violent methods, particularly firearms. The authors conclude that these results underscore the importance of follow-up care to help ensure the safety of self-harm patients.
Citation: Olfson M, Wall M, Wang S . Suicide after deliberate self-harm in adolescents and young adults. Pediatrics 2018 Apr;141(4). doi: 10.1542/peds.2017-3517..
Keywords: Children/Adolescents, Medicaid, Behavioral Health, Risk, Young Adults
Gonzales G, Golberstein E, Hill SC
AHRQ Author: Hill, SC; Zuvekas, SH
Psychological distress and enrollment in Medicaid.
Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
Citation: Gonzales G, Golberstein E, Hill SC . Psychological distress and enrollment in Medicaid. J Behav Health Serv Res 2017 Oct;44(4):523-35. doi: 10.1007/s11414-016-9532-9.
Keywords: Access to Care, Policy, Medicaid, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Olesiuk WJ, Farley JF, Domino ME
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
The purpose of this study was to determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders. The study concluded that medical-home enrollment is generally associated with greater likelihood of receiving guideline-concordant diabetes care for Medicaid enrollees with diabetes and schizophrenia.
AHRQ-funded; HS023099; HS019659; HS000032.
Citation: Olesiuk WJ, Farley JF, Domino ME . Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia? J Health Care Poor Underserved 2017;28(3):1030-41. doi: 10.1353/hpu.2017.0094..
Keywords: Care Management, Diabetes, Medicaid, Behavioral Health, Patient-Centered Healthcare
Burns ME, Huskamp HA, Smith JC
The effects of the transition from Medicaid to Medicare on health care use for adults with mental illness.
The researchers estimated the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with serious mental illness on health care use, overall and related to mental health and substance use disorders. They found that after 12 months of dual coverage, the probability of outpatient care use increased in both states from 4 percent to 9 percent.
Citation: Burns ME, Huskamp HA, Smith JC . The effects of the transition from Medicaid to Medicare on health care use for adults with mental illness. Med Care 2016 Sep;54(9):868-77. doi: 10.1097/mlr.0000000000000572.
Keywords: Behavioral Health, Medicaid, Medicare, Hospitalization, Healthcare Utilization
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
Citation: Creedon TB, Cook BL . Access to mental health care increased but not for substance use, while disparities remain. Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Garfield LD, Brown DS, Allaire BT
Psychotropic drug use among preschool children in the Medicaid program from 36 states.
The researchers examined utilization of the most commonly used psychotropic medications among children aged 4 years and younger. They determined the prevalence of and indications for psychotropic medication among preschool children in Medicaid. Their study found that preschoolers are receiving psychotropic medications despite limited evidence supporting safety or efficacy. Medications for attention-deficit disorder/attention-deficit hyperactivity disorder treatment were most common.
Citation: Garfield LD, Brown DS, Allaire BT . Psychotropic drug use among preschool children in the Medicaid program from 36 states. Am J Public Health 2015 Mar;105(3):524-9. doi: 10.2105/ajph.2014.302258..
Keywords: Children/Adolescents, Medication, Medicaid, Behavioral Health
Madden JM, Adams AS, LeCates RF
Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D.
This study examined the effects of transitioning to Part D coverage among disabled dual enrollees with schizophrenia or a bipolar disorder, comparing enrollees in states with strict Medicaid cap policies with enrollees in states without caps. It found significant reductions in the number of people with a serious mental illness who were not treated owing to the transition to Part D from strictly capped Medicaid coverage.
Citation: Madden JM, Adams AS, LeCates RF . Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D. JAMA Psychiatry 2015 Feb;72(2):179-88. doi: 10.1001/jamapsychiatry.2014.1259..
Keywords: Behavioral Health, Medication, Medicare, Medicaid, Depression
Raghavan R, Brown DS, Allaire BT
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
The authors aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for children with histories of abuse or neglect. They concluded that Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.
Citation: Raghavan R, Brown DS, Allaire BT . Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States. Psychiatr Serv 2014 Dec;65(12):1445-51. doi: 10.1176/appi.ps.201400028.
Keywords: Children/Adolescents, Healthcare Costs, Medicaid, Medication, Behavioral Health
Saloner B, Matone M, Kreider AR
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
The authors compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. They found that carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use.
AHRQ-funded; HS020269; HS018550.
Citation: Saloner B, Matone M, Kreider AR . Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health. Psychiatr Serv 2014 Dec;65(12):1458-64. doi: 10.1176/appi.ps.201300574.
Keywords: Children/Adolescents, Healthcare Utilization, Medicaid, Medication, Behavioral Health
Finnerty M, Neese-Todd S, Bilder S
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
The authors describe the Medicaid/ Mental Health Network for Evidence-Based Treatment (MEDNET), the first multistate Medicaid QI collaborative to focus on improving psychotropic prescribing. In particular, this article includes the development, infrastructure challenges, and early evidence of success of this public-academic partnership.
AHRQ-funded; HSO19937; HS021112.
Citation: Finnerty M, Neese-Todd S, Bilder S . Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices. Psychiatr Serv 2014 Nov 1;65(11):1297-9. doi: 10.1176/appi.ps.201400343..
Keywords: Behavioral Health, Evidence-Based Practice, Medication, Medicaid, Practice Patterns
Vanderwerker L, Akincigil A, Olfson M
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
The researchers investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. They found that foster care youths had higher rates of externalizing disorders than the comparison group and greater antipsychotic use. Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates.
AHRQ-funded; HS017918; HS019937; HS021112.
Citation: Vanderwerker L, Akincigil A, Olfson M . Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatr Serv 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
Keywords: Children/Adolescents, Medication, Medicaid, Vulnerable Populations, Behavioral Health
Regenstein M, Andres E
Reducing hospital readmissions among Medicaid patients: a review of the literature.
This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. It concluded that much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population.
Citation: Regenstein M, Andres E . Reducing hospital readmissions among Medicaid patients: a review of the literature. Qual Manag Health Care 2014 Oct-Dec;23(4):203-25. doi: 10.1097/qmh.0000000000000043..
Keywords: Hospital Readmissions, Medicaid, Behavioral Health, Substance Abuse, Social Determinants of Health
Hartung DM, Zerzan J, Yamashita T
Characteristics and trends of low-dose quetiapine use in two western state Medicaid programs.
This study characterized longitudinal trends in low-dose second-generation antipsychotic medications, and, in particular, quetiapine in two western State Medicaid programs over a 5-year period. The researchers found that when one State suspended off-label promotional activities, there was a significant decline in the initiation of low-dose quetiapine use.
AHRQ-funded; HS019456; HS019464.
Citation: Hartung DM, Zerzan J, Yamashita T . Characteristics and trends of low-dose quetiapine use in two western state Medicaid programs. Pharmacoepidemiol Drug Saf. 2014 Jan;23(1):87-94. doi: 10.1002/pds.3538..
Keywords: Medication, Medicaid, Behavioral Health
Hartung DM, Middleton L, McFarland BH
Use of administrative data to identify off-label use of second-generation antipsychotics in a Medicaid population.
The researchers sought to determine the accuracy of administrative claims for identifying off-label use of second-generation antipsychotics (SGAs) in a Medicaid population. They found that Medicaid claims data had high predictive ability for identifying users of SGAs who did not have documentation of schizophrenia or bipolar disorder in the medical record.
Citation: Hartung DM, Middleton L, McFarland BH . Use of administrative data to identify off-label use of second-generation antipsychotics in a Medicaid population. Psychiatr Serv. 2013 Dec;64(12):1236-42. doi: 10.1176/appi.ps.005482012..
Keywords: Medicaid, Behavioral Health, Medication