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CHING-CHING
LIN
Author
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical.
Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations.
Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
Summer 2017
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
Ching-Ching
Lin
Author
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical.
Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations.
Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
Summer 2017
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS
WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and
is estimated to have the highest healthcare utilization among other subgroups. Diabetes
and major depressive disorder are two of the most common chronic conditions co-occurring
among the multiple chronic conditions population. Like other individuals with multiple
chronic conditions, those with co-occurring diabetes and major depressive disorder tend to
incur higher healthcare utilization but lower rates of guideline-concordant care, compared
to patients with either condition only. Primary care physicians and mental health
specialists are two major provider types that provide depression care. While the shortage
of mental health specialist supply keeps the rate of mental health specialist use low,
primary care physicians have become more engaged in providing depression care, as the
treatment modality shifts increasingly towards more pharmacotherapy. Some research has
demonstrated that mental health specialist care leads to higher level of
guideline-concordant depression care than primary care in individuals with depression. Yet
evidence of the impact of mental health specialist care on guideline-concordant care in
individuals with co-occurring diabetes and major depressive disorder has not yet been
determined. As individuals with diabetes and major depressive disorder are mainly managed
at primary care, examining the role of the mental health specialist among this population
is critical. Using an economics theoretical framework, the objective of this study is to
examine whether mental health specialist use affects guideline-concordant care and
emergency department/hospitalization care among adult Medicaid beneficiaries with
co-occurring diabetes and major depressive disorder. First, with mental health specialist
supply as instrumental variables and person-level fixed effect specification, this study
examined the effect of mental health specialist care on primary care visit as well as
guideline-concordant care for both major depressive disorder and diabetes in the study
population. Second, this study investigated the effect of mental health specialist care on
emergency department and hospitalization care utilization with instrumental variables and
General Estimating Equations method. Results from this study show that mental health
specialist care increases likelihood of receiving guideline-concordant depression care. It
also increases probabilities of visiting a primary care provider and receiving annual eye
exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally,
mental health specialist care is found to reduce both overall number of all-cause
emergency department visits and likelihood of all-cause hospitalizations. Findings from
this dissertation suggest that individuals with co-occurring diabetes and major depressive
disorder will benefits from mental health specialist care as quality of depression care
improves and tertiary care utilization reduces. Nevertheless, the negative effect of
mental health specialist care on some guideline-concordant diabetes care also implies
that, for individuals with multiple chronic conditions, any policy aiming to improve
mental health care delivery also needs to address the spillover effect of mental health
care on other co-occurring conditions. Several areas for future research exist that can
advance our understanding of mental health specialist care in order to inform future
policy decisions regarding programs aimed at improving mental health care for people with
multiple chronic conditions.
Summer 2017
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department,
Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
Summer 2017
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017-08
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George M.
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression; Diabetes; Emergency Department; Hospitalization; Mental Health Specialist; Quality of Care
eng
Doctor of Philosophy
Dissertation
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George M.
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George M.
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression, Diabetes, Emergency Department, Hospitalization, Mental Health Specialist, Quality of Care
eng
Doctor of Philosophy
Dissertation
Health Policy and Management
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George M.
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
Ching-Ching
Lin
Creator
Department of Health Policy and Management
Gillings School of Global Public Health
THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION
The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
2017
Home economics
Health care management
Economics
Depression; Diabetes; Emergency Department; Hospitalization; Mental Health Specialist; Quality of Care
eng
Doctor of Philosophy
Dissertation
Marisa
Domino
Thesis advisor
Bradley
Gaynes
Thesis advisor
George M.
Holmes
Thesis advisor
Frank
Sloan
Thesis advisor
Morris
Weinberger
Thesis advisor
text
2017-08
University of North Carolina at Chapel Hill
Degree granting institution
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