Effects of a behavioral health carve-out on inpatient-related quality indicators for major depression treatment.
OBJECTIVE
To analyze the effects of the 1993 Massachusetts behavioral health carve-out for state employees on readmissions and follow-up treatment after hospitalization for major depressive disorder (MDD).


METHODS
The sample consisted of 218 continuous enrollees in preferred provider organization and/or indemnity plans who had any MDD admissions during fiscal years 1992 to 1995. These users accounted for 310 MDD admissions. Eligibility files and behavioral health claims were used to analyze readmissions and follow-up treatment after discharge. Kaplan-Meier survival functions were obtained for pre/post (pre-carve-out vs. post-carve-out) comparisons of the two indicators. Cox regression models were used to estimate carve-out effects on readmission and follow-up treatment while controlling for patient variables. Postdischarge contact categories were also compared.


RESULTS
The risk of readmission did not change significantly after the carve-out, in either the Kaplan-Meier or Cox regression analyses. Follow-up treatment was significantly more likely after the carve-out, including in the early postdischarge period. There was a significant decrease in the proportion of discharged patients followed by readmission only, and a significant increase in patients receiving follow-up treatment prior to a readmission.


CONCLUSIONS
Under this behavioral health carve-out, follow-up treatment was more likely, and estimated risk of readmission did not change significantly for a seriously ill subgroup of enrollees. This was true even when controlling for patient variables and using data for extended time "at risk" for each indicator. Future research on carveouts should move toward direct clinical quality measurement.
Merrick
E L
EL
Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02454-9110, USA. merrick@brandeis.edu
D000293:Adolescent; D000328:Adult; D003284:Contract Services / Q000191:economics / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011243:Preferred Provider Organizations / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D013219:State Government; D016896:Treatment Outcome