Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health

Brendan Saloner, Meredith Matone, Amanda R. Kreider, M. Samer Budeir, Dorothy Miller, Yuan Shung Huang, Ramesh Raghavan, Benjamin French, David Rubin

    Research output: Contribution to journalArticle

    Abstract

    Objective: Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. Methods: Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates. Results: With adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95%confidence interval [CI]=1.26-2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08-1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics. Conclusions: Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.

    Original languageEnglish (US)
    Pages (from-to)1458-1464
    Number of pages7
    JournalPsychiatric Services
    Volume65
    Issue number12
    DOIs
    StatePublished - Dec 1 2014

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    Medicaid
    Antipsychotic Agents
    Mental Health
    Fee-for-Service Plans
    Logistic Models
    Odds Ratio
    Confidence Intervals
    Managed Care Programs
    Inpatients
    Organizations
    Health

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Saloner, B., Matone, M., Kreider, A. R., Budeir, M. S., Miller, D., Huang, Y. S., ... Rubin, D. (2014). Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health. Psychiatric Services, 65(12), 1458-1464. https://doi.org/10.1176/appi.ps.201300574

    Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health. / Saloner, Brendan; Matone, Meredith; Kreider, Amanda R.; Budeir, M. Samer; Miller, Dorothy; Huang, Yuan Shung; Raghavan, Ramesh; French, Benjamin; Rubin, David.

    In: Psychiatric Services, Vol. 65, No. 12, 01.12.2014, p. 1458-1464.

    Research output: Contribution to journalArticle

    Saloner, B, Matone, M, Kreider, AR, Budeir, MS, Miller, D, Huang, YS, Raghavan, R, French, B & Rubin, D 2014, 'Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health', Psychiatric Services, vol. 65, no. 12, pp. 1458-1464. https://doi.org/10.1176/appi.ps.201300574
    Saloner, Brendan ; Matone, Meredith ; Kreider, Amanda R. ; Budeir, M. Samer ; Miller, Dorothy ; Huang, Yuan Shung ; Raghavan, Ramesh ; French, Benjamin ; Rubin, David. / Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health. In: Psychiatric Services. 2014 ; Vol. 65, No. 12. pp. 1458-1464.
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    abstract = "Objective: Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. Methods: Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates. Results: With adjustment for person-level covariates, second-generation antipsychotic use was 31{\%} higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95{\%}confidence interval [CI]=1.26-2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08-1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics. Conclusions: Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.",
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    AU - Saloner, Brendan

    AU - Matone, Meredith

    AU - Kreider, Amanda R.

    AU - Budeir, M. Samer

    AU - Miller, Dorothy

    AU - Huang, Yuan Shung

    AU - Raghavan, Ramesh

    AU - French, Benjamin

    AU - Rubin, David

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    N2 - Objective: Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. Methods: Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates. Results: With adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95%confidence interval [CI]=1.26-2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08-1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics. Conclusions: Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.

    AB - Objective: Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. Methods: Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates. Results: With adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95%confidence interval [CI]=1.26-2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08-1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics. Conclusions: Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.

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