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Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities

      Introduction

      Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations.

      Method

      Employing the linked data sets of the 2012–2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care–sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016–August 2017.

      Results

      Multilevel regression showed that local health departments’ provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care–sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments’ direct provision of mental health preventive care could reduce 9% of the racial disparities.

      Conclusions

      Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.
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      References

        • Roehrig C.
        Mental disorders top the list of the most costly conditions in the United States: $201 billion.
        Health Aff (Millwood). 2016; 35: 1130-1135https://doi.org/10.1377/hlthaff.2015.1659
      1. Goodell S, Druss BG, Walker ER. Mental disorders and medical comorbidity. www.rwjf.org/en/library/research/2011/02/mental-disorders-and-medical-comorbidity.html. Published 2011. Accessed August 19, 2017.

        • McGuire T.G.
        • Alegria M.
        • Cook B.L.
        • Wells K.B.
        • Zaslavsky A.M.
        Implementing the Institute of Medicine definition of disparities: an application to mental health care.
        Health Serv Res. 2006; 41: 1979-2005https://doi.org/10.1111/j.1475-6773.2006.00583.x
        • Institute of Medicine
        Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2003; https://doi.org/10.17226/12875
        • Costich J.F.
        • Scutchfield F.D.
        • Ingram R.C.
        Population health, public health, and accountable care: emerging roles and relationships.
        Am J Public Health. 2015; 105: 846-850https://doi.org/10.2105/AJPH.2014.302484
      2. CDC/National Center for Health Statistics. Healthy People 2020. www.cdc.gov/nchs/healthy_people/hp2020.htm. Published 2011. Accessed August 21, 2017.

        • Horvitz-Lennon M.
        • Kilbourne A.M.
        • Pincus H.A.
        From silos to bridges: meeting the general health care needs of adults with severe mental illnesses.
        Health Aff (Millwood). 2006; 25: 659-669https://doi.org/10.1377/hlthaff.25.3.659
      3. Substance Abuse Mental Health Services Administration. Integrated treatment for co-occurring disorders: Building your program. https://store.samhsa.gov/shin/content/SMA08-4367/BuildingYourProgram-ITC.pdf. Published 2009. Accessed August 21, 2017.

      4. Substance Abuse Mental Health Services Administration. Behavioral Health in Primary Care / SAMHSA-HRSA. www.samhsa.gov/integrated-health-solutions. Published 2017. Accessed August 21, 2017.

      5. Gerrity M. Evolving models of behavioral health integration: evidence update 2010–2015. www.milbank.org/publications/evolving-models-of-behavioral-health-integration-evidence-update-2010-2015/. Published 2016. Accessed August 21, 2017.

        • Bruce M.L.
        • Ten Have T.R.
        • Reynolds 3rd, C.F.
        • et al.
        Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial.
        JAMA. 2004; 291: 1081-1091https://doi.org/10.1001/jama.291.9.1081
        • Clarke R.M.
        • Jeffrey J.
        • Grossman M.
        • Strouse T.
        • Gitlin M.
        • Skootsky S.A.
        Delivering on accountable care: lessons from a behavioral health program to improve access and outcomes.
        Health Aff (Millwood). 2016; 35: 1487-1493https://doi.org/10.1377/hlthaff.2015.1263
        • Purtle J.
        • Klassen A.C.
        • Kolker J.
        • Buehler J.W.
        Prevalence and correlates of local health department activities to address mental health in the United States.
        Prev Med. 2016; 82: 20-27https://doi.org/10.1016/j.ypmed.2015.11.007
        • Grembowski D.
        • Bekemeier B.
        • Conrad D.
        • Kreuter W.
        Are local health department expenditures related to racial disparities in mortality?.
        Soc Sci Med. 2010; 71: 2057-2065https://doi.org/10.1016/j.socscimed.2010.09.004
        • Ingram R.C.
        • Scutchfield F.D.
        • Charnigo R.
        • Riddell M.C.
        Local public health system performance and community health outcomes.
        Am J Prev Med. 2012; 42: 214-220https://doi.org/10.1016/j.amepre.2011.10.022
        • Brown T.T.
        • Martinez-Gutierrez M.S.
        • Navab B.
        The impact of changes in county public health expenditures on general health in the population.
        Health Econ Policy Law. 2014; 9: 251-269https://doi.org/10.1017/S1744133114000024
        • Mays G.P.
        • Smith S.A.
        Evidence links increases in public health spending to declines in preventable deaths.
        Health Aff (Millwood). 2011; 30: 1585-1593https://doi.org/10.1377/hlthaff.2011.0196
        • Shah G.H.
        • Luo H.
        • Winterbauer N.
        • Madamala K.
        Addressing psychological, mental health and other behavioural healthcare needs of the underserved populations in the United States: the role of local health departments.
        Persp Public Health. 2016; 136: 86-92https://doi.org/10.1177/1757913915597960
      6. CDC. Public health action plan to integrate mental health promotion and mental illness prevention with chronic disease prevention. www.mhrb.org/dbfiles/docs/Brochure/11_220990_Sturgis_MHMIActionPlan_FINAL-Web_tag508.pdf. Published 2011. Accessed August 21, 2017.

        • Hyde J.K.
        • Shortell S.M.
        The structure and organization of local and state public health agencies in the U.S.: a systematic review.
        Am J Prev Med. 2012; 42 (suppl 1): S29-S41https://doi.org/10.1016/j.amepre.2012.01.021
        • Hendryx M.S.
        • Ahern M.M.
        Access to mental health services and health sector social capital.
        Adm Policy Ment Health. 2001; 28: 205-218https://doi.org/10.1023/A:1007860002137
        • McLeroy K.R.
        • Bibeau D.
        • Steckler A.
        • Glanz K.
        An ecological perspective on health promotion programs.
        Health Educ Q. 1988; 15: 351-377https://doi.org/10.1177/109019818801500401
        • Croft B.
        • Parish S.L.
        Care integration in the Patient Protection and Affordable Care Act: implications for behavioral health.
        Adm Policy Ment Health. 2013; 40: 258-263https://doi.org/10.1007/s10488-012-0405-0
        • Stokols D.
        Translating social ecological theory into guidelines for community health promotion.
        Am J Health Promot. 1996; 10: 282-298https://doi.org/10.4278/0890-1171-10.4.282
        • Mays G.P.
        • McHugh M.C.
        • Shim K.
        • et al.
        Institutional and economic determinants of public health system performance.
        Am J Public Health. 2006; 96: 523-531https://doi.org/10.2105/AJPH.2005.064253
        • Luo H.
        • Sotnikov S.
        • Shah G.
        Local health department activities to ensure access to care.
        Am J Prev Med. 2013; 45: 720-727https://doi.org/10.1016/j.amepre.2013.07.010
        • Morrissey J.
        • Calloway M.
        • Bartko W.T.
        • Ridgely M.S.
        • Goldman H.H.
        • Paulson R.I.
        Local mental health authorities and service system change: evidence from the Robert Wood Johnson program on chronic mental illness.
        Milbank Q. 1994; 72: 49-80https://doi.org/10.2307/3350338
        • Scutchfield F.D.
        • Howard A.F.
        Moving on upstream: the role of health departments in addressing socioecologic determinants of disease.
        Am J Prev Med. 2011; 40: S80-S83https://doi.org/10.1016/j.amepre.2010.10.003
        • Schur C.L.
        • Lucado J.L.
        • Feldman J.
        Local public health capacities to address the needs of culturally and linguistically diverse populations.
        J Public Health Manag Pract. 2011; 17: 177-186https://doi.org/10.1097/PHH.0b013e3181fb0037
      7. Agency for Healthcare Research and Quality. Ambulatory care sensitive conditions: age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population younger than age 75 years. www.qualitymeasures.ahrq.gov/summaries/summary/48964. Published 2015. Accessed August 21, 2017.

      8. Moran M. High mental illness costs attributed in part to avoidable hospital use. http://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2015.1a18. Published 2014. Accessed August 21, 2017.

      9. National Association of County and City Health Officials. 2013 national profile of local health departments. http://archived.naccho.org/topics/infrastructure/profile/upload/2013-National-Profile-of-Local-Health-Departments-report.pdf. Published 2014. Accessed August 21, 2017.

      10. Centers for Medicare and Medicaid Services. State Innovation Models Initiative: general information. https://innovation.cms.gov/initiatives/state-innovations/. Published 2017. Accessed August 21, 2017.

        • Rajkumar R.
        • Patel A.
        • Murphy K.
        • et al.
        Maryland’s all-payer approach to delivery-system reform.
        N Engl J Med. 2014; 370: 493-495https://doi.org/10.1056/NEJMp1314868
      11. Agency for Healthcare Research and Quality. Prevention quality indicators technical specifications—Version 6.0. www.qualityindicators.ahrq.gov/modules/PQI_TechSpec.aspx. Published 2016. Accessed August 21, 2017.

      12. Agency for Healthcare Research and Quality. Emergency department use for mental and substance use disorders. www.hcup-us.ahrq.gov/reports/ED_Multivar_Rpt_Revision_Final072010.pdf. Published 2010. Accessed August 21, 2017.

        • Norcross JC G.M.
        Handbook of Psychotherapy Integration. 2nd ed. Oxford University Press, Oxford2005https://doi.org/10.1093/med:psych/9780195165791.001.0001
      13. Office of the Surgeon General. Mental Health: A Report of the Surgeon General. https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS. Published 1999. Accessed August 21, 2017.

      14. CDC. Public health system and the 10 essential public health services—NPHPSP. www.cdc.gov/nphpsp/essentialservices.html. Published 2013. Accessed August 21, 2017.

        • Burris S.
        • Mays G.P.
        • Douglas Scutchfield F.
        • Ibrahim J.K.
        Moving from intersection to integration: public health law research and public health systems and services research.
        Milbank Q. 2012; 90: 375-408https://doi.org/10.1111/j.1468-0009.2012.00667.x
        • Le Cook B.
        • McGuire T.G.
        • Lock K.
        • Zaslavsky A.M.
        Comparing methods of racial and ethnic disparities measurement across different settings of mental health care.
        Health Serv Res. 2010; 45: 825-847https://doi.org/10.1111/j.1475-6773.2010.01100.x
        • Dinwiddie G.Y.
        • Gaskin D.J.
        • Chan K.S.
        • Norrington J.
        • McCleary R.
        Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health.
        Soc Sci Med. 2013; 80: 67-75https://doi.org/10.1016/j.socscimed.2012.11.024
        • Cook B.L.
        • Zuvekas S.H.
        • Chen J.
        • Progovac A.
        • Lincoln A.K.
        Assessing the individual, neighborhood, and policy predictors of disparities in mental health care.
        Med Care Res Rev. 2017; 74: 404-430https://doi.org/10.1177/1077558716646898
        • Andersen R.M.
        Revisiting the behavioral model and access to medical care: does it matter?.
        J Health Soc Behav. 1995; 36: 1-10https://doi.org/10.2307/2137284
        • Cummings J.R.
        • Wen H.
        • Ko M.
        • Druss B.G.
        Race/ethnicity and geographic access to Medicaid substance use disorder treatment facilities in the United States.
        JAMA Psychiatry. 2014; 71: 190-196https://doi.org/10.1001/jamapsychiatry.2013.3575
        • Rodriguez H.P.
        • Chen J.
        • Owusu-Edusei K.
        • Suh A.
        • Bekemeier B.
        Local public health systems and the incidence of sexually transmitted diseases.
        Am J Public Health. 2012; 102: 1773-1781https://doi.org/10.2105/AJPH.2011.300497
        • Raudenbush S.W.
        • Bryk A.S.
        Hierarchical Linear Models: Applications and Data Analysis Methods.
        University of Chicago Press, Chicago2002
        • Fairlie R.W.
        An extension of the blinder-oaxaca decomposition technique to logit and probit models.
        J Econ Soc Meas. 2005; 30: 305-316
        • Oaxaca R.L.
        • Ransom M.R.
        Identification in detailed wage decompositions.
        Rev Econ Stat. 1999; 81: 154-157https://doi.org/10.1162/003465399767923908
        • Chen J.
        • Rizzo J.
        Racial and ethnic disparities in use of psychotherapy: evidence from U.S. national survey data.
        Psy Serv. 2010; 61: 364-372https://doi.org/10.1176/ps.2010.61.4.364
        • Chen J.
        • Rizzo J.A.
        Racial and ethnic disparities in antidepressant drug use.
        J Ment Health Policy Econ. 2008; 11: 155-165
      15. Simon GE. Mental health research network: a population-based approach to transform research. https://iths.pure.elsevier.com/en/projects/mental-health-research-network-a-population-based-approach-to-tra. Published 2013. Accessed August 21, 2017.

      16. Unützer J, Harbin H, Schoenbaum M, Druss B. The collaborative care model: an approach for integrating physical and mental health care in Medicaid health homes. https://aims.uw.edu/resource-library/collaborative-care-model-approach-integrating-physical-and-mental-health-care. Published 2013. Accessed August 21, 2017.

      17. National Institute of Mental Health. Strategic research priorities overview. www.nimh.nih.gov/about/strategic-planning-reports/strategic-research-priorities/index.shtml. Published 2016. Accessed August 21, 2017.