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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 15 of 15 Research Studies Displayed
Presskreischer R, Steinglass JE, Anderson KE
Eating disorders in the U.S. Medicare population.
This cross-sectional study explored the prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. A representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records was used. The sample included almost 12 million Medicare enrollees of whom 0.15% had an eating disorder diagnosis. A greater proportion of individuals diagnosed with an eating disorder diagnosis were female, under age 65, and dually eligible for Medicaid due to disability or low-income qualification than those without a diagnosis. Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias, arthritis, and thyroid conditions. Spending was $29,456 for enrollees with eating disorders compared to $7,418 without.
Citation: Presskreischer R, Steinglass JE, Anderson KE . Eating disorders in the U.S. Medicare population. Int J Eat Disord 2022 Mar;55(3):362-71. doi: 10.1002/eat.23676..
Keywords: Behavioral Health, Medicare, Healthcare Costs
Luo Z, Gritz M, Connelly L
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
The objective of this study was to fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. The investigators concluded that although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years.
Citation: Luo Z, Gritz M, Connelly L . A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients. J Gen Intern Med 2021 Sep;36(9):2700-08. doi: 10.1007/s11606-021-06596-w..
Keywords: Primary Care, Obesity, Behavioral Health, Medicare, Elderly
Olfson M, Stroup TS, Huang C
Suicide risk in Medicare patients with schizophrenia across the life span.
The purpose of this study was to describe suicide mortality rates and correlates among adults with schizophrenia across the life span and standardized mortality ratios (SMRs) for suicide compared with the general US population. The investigators concluded that in this cohort study of adult Medicare patients with schizophrenia, suicide risk was elevated, with the highest absolute and relative risk among young adults. They indicated that these patterns supported suicide prevention efforts with a focus on young adults with schizophrenia, especially those with suicidal symptoms and substance use.
Citation: Olfson M, Stroup TS, Huang C . Suicide risk in Medicare patients with schizophrenia across the life span. JAMA Psychiatry 2021 Aug;78(8):876-85. doi: 10.1001/jamapsychiatry.2021.0841..
Keywords: Medicare, Behavioral Health
Hua CL, Cornell PY, Zimmerman S
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
This study examined trends in the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States over time and in relationship to characteristics such as dual eligibility and health conditions. Using Medicare data, findings showed that the prevalence of SMI in AL increased by 54% from 2007 to 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. Approximately 10% of AL communities had over half of the sample's AL residents with SMI.
Citation: Hua CL, Cornell PY, Zimmerman S . Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017. Am J Geriatr Psychiatry 2021 May;29(5):434-44. doi: 10.1016/j.jagp.2020.09.011..
Keywords: Elderly, Behavioral Health, Nursing Homes, Long-Term Care, Medicare
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
Citation: Fung V, Price M, Nierenberg AA . Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees. JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords: Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Germack HD, Bizhanova Z, Roberts ET
Substantial hospital level variation in all-cause readmission rates among Medicare beneficiaries with serious mental illness.
This study’s purpose was to examine the variation across hospitals in readmissions for patients with serious mental illness (SMI) and differences in the characteristics of hospitals with the highest and lowest readmission rates. A cross-sectional analysis was conducted of pooled inpatient claims from 2013-2016. The 5% sample of fee-for-service Medicare beneficiaries included patients with SMI. The authors identified 2066 hospitals with at least 30 index admissions for Medicare beneficiaries with SMI. Factors most strongly associated with increased risk of readmission included substance use disorder and end stage renal disease. Hospital readmission rates ranged from 7.05% to 15.24%. Hospitals with the lowest adjusted readmission rates were more likely to be teaching hospitals and located in the South or Midwest.
Citation: Germack HD, Bizhanova Z, Roberts ET . Substantial hospital level variation in all-cause readmission rates among Medicare beneficiaries with serious mental illness. Healthc 2020 Sep;8(3):100453. doi: 10.1016/j.hjdsi.2020.100453..
Keywords: Elderly, Behavioral Health, Hospital Readmissions, Medicare, Hospitals, Hospitalization
Rhee TG, Olfson M, Sint K
Characterization of the quality of electroconvulsive therapy among older Medicare beneficiaries.
Electroconvulsive therapy (ECT) is an important therapy for treatment-resistant depression and is especially effective for elderly individuals with depression. This study provides the first US nationally representative description of ECT in the elderly. The investigators concluded that despite substantial evidence of efficacy, ECT use remained rare among elderly patients with depression.
Citation: Rhee TG, Olfson M, Sint K . Characterization of the quality of electroconvulsive therapy among older Medicare beneficiaries. J Clin Psychiatry 2020 Jul 7;81(4). doi: 10.4088/JCP.19m13186.
Keywords: Elderly, Medicare, Depression, Behavioral Health, Treatments, Patient-Centered Outcomes Research
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
Citation: Cook BL, Flores M, Zuvekas SH . The impact Of Medicare's mental health cost-sharing parity on use of mental health care services. Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Belenky N, Pence BW, Cole SR
Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV.
This study examined the potential effects on mental health treatment and outcomes for dual Medicare-Medicaid eligible women with HIV when Medicare Part D was implemented in 2006. Data from the Women’s Interagency HIV Study from 2003-2008 was used. No disruptive effects were found with changes in antidepressant use, depressive symptoms or hospitalization.
AHRQ-funded; HS024858; HS000032.
Citation: Belenky N, Pence BW, Cole SR . Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV. AIDS Care 2019 Apr;31(4):505-12. doi: 10.1080/09540121.2018.1516283..
Keywords: Behavioral Health, Human Immunodeficiency Virus (HIV), Medicare, Medication
Albrecht JS, Peters ME, Smith GS
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
This study estimated rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries. After TBI, 16,519 (17 percent) beneficiaries were diagnosed with anxiety and 269 (0.3 percent) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time.
Citation: Albrecht JS, Peters ME, Smith GS . Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury. J Head Trauma Rehabil 2017 May/Jun;32(3):178-84. doi: 10.1097/htr.0000000000000266.
Keywords: Anxiety, Brain Injury, Medicare, Behavioral Health, Trauma
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
Singh G, Zhang W, Kuo YF
Association of psychological disorders with 30-day readmission rates in patients with COPD.
Using a 5 percent sample of Medicare beneficiaries, the researchers examined the association of psychological disorders such as depression, anxiety, psychosis, alcohol abuse and drug abuse with early readmission for patients with COPD. They found that psychological disorders like depression, anxiety, psychosis, alcohol abuse and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.
AHRQ-funded; HS020642; HS022134.
Citation: Singh G, Zhang W, Kuo YF . Association of psychological disorders with 30-day readmission rates in patients with COPD. Chest 2016 Apr;149(4):905-15. doi: 10.1378/chest.15-0449..
Keywords: Behavioral Health, Hospital Readmissions, Medicare, Respiratory Conditions
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
Citation: Zhang Y, Talisa V, Baik SH . Part D plan switching among Medicare beneficiaries with schizophrenia. Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
Keywords: Healthcare Costs, Medicare, Behavioral Health, Value
Zhang Y, Baik SH, Newhouse JP
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
The investigators simulated Medicare Part D savings from replacing random assignment with an "intelligent assignment" algorithm that would assign beneficiaries to the least expensive plan in 2010 based on their drug usage in the previous year. They found that intelligent assignment could have saved about $150 million for Medicare and beneficiaries with schizophrenia combined in 2010.
Citation: Zhang Y, Baik SH, Newhouse JP . Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings. Health Aff 2015 Mar;34(3):455-60. doi: 10.1377/hlthaff.2014.1227.
Keywords: Healthcare Costs, Medicare, Medication, Behavioral Health, Value
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