Adjusting for patient characteristics and selection effects in assessment of community mental health centers.
OBJECTIVE
The objective of this study was to determine the effect of patient socioeconomic characteristics and center selection of patients on measured performance of community mental health centers.


METHODS
Data were taken from the administrative records of Indiana's public mental health system for 16,516 adults with severe, persistent mental illness treated in 30 community mental health centers. Center performance was compared using longitudinal information on patient functioning.


METHODS
A mixed random-effects model that is suitable for fitting data with a hierarchical structure was used to assess relative performance.


RESULTS
Measured performance was found to depend significantly on patient education, income, marital status, race, ethnicity, and baseline health (P<0.05). Results also indicated centers that were more successful at maintaining patients in treatment were unfairly underranked by unadjusted performance scores.


CONCLUSIONS
Both the socioeconomic background of patients and patient selection by centers impact apparent performance in community mental health care. If observational data are used to evaluate community-based providers, analysts might need to account for both effects to ensure comparisons of relative performance are accurate.
Deb
Partha
P
Department of Economics, Hunter College-City University of New York, New York, NY 10021, USA. partha.deb@hunter.cuny.edu
Holmes
Ann M
AM
Deliberty
Richard N
RN
D000328:Adult; D000339:Affect; D001294:Attitude to Health; D003155:Community Mental Health Centers / Q000592:standards*; D003627:Data Interpretation, Statistical; D004522:Educational Status; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006302:Health Services Research / Q000379:methods / Q000592:standards*; D006304:Health Status; D006801:Humans; D007182:Income; D007196:Indiana; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008603:Mental Health; D017711:Nonlinear Dynamics; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D044469:Racial Groups; D012307:Risk Factors; D015983:Selection Bias; D012959:Socioeconomic Factors