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Provider Continuity and Outcomes of Care for Persons with Schizophrenia

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Mental Health Services Research

Abstract

The study examines the relationship of provider continuity to outcomes of care (quality of life, payments for services) for Medicaid beneficiaries with schizophrenia. Data sources included Maryland Medicaid claims and enrollment data and in-person interviews. Measures of provider continuity over the year preceding the interview, calculated from claims for mental health ambulatory visits, were usual provider continuity (UPC—fraction of visits to the most frequently seen provider), sequential continuity (SECON—fraction of sequential visit pairs to the same provider), and continuity of care (COC—distribution of visits across different providers). Higher provider continuity was found to be related to lower costs and to lower likelihood of mental illness hospitalization. Provider continuity was not significantly related to general life satisfaction or to satisfaction with health. Persons with zero or one visit in a year (and for whom provider continuity could not be measured) had more severe depressive symptoms and were more likely to abuse substances but reported comparable satisfaction with health and overall quality of life while incurring lower Medicaid costs.

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REFERENCES

  • Bachrach, L. L. (1993). Continuity of care and approaches to case management for long term mentally ill patients. Hospital and Community Psychiatry, 44, 465-468.

    Google Scholar 

  • Becker, M. H., Drachman, R. H., & Krischt, J. P. (1974). A field experiment to evaluate various outcomes of continuity of physician care. American Journal of Public Health, 64, 1062-1070.

    Google Scholar 

  • Breslau, N., & Reeb, K. G. (1975). Continuity of care in a university-based practice. Journal of Medical Education, 50, 965-969.

    Google Scholar 

  • Chien, C. F. (1997). Measurement and impact of provider continuity: An application to schizophrenia patients, Unpublished doctoral dissertation, Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health.

    Google Scholar 

  • Heagarty, M. C., Robertson, L. S. J., Kosa, J., & Alpert, J. J. (1970). Some comparative costs in comprehensive versus fragmented pediatric care. Pediatrics, 46, 596-603.

    Google Scholar 

  • Kissling, W. (1992). Ideal and reality of neuroleptic relapse prevention. British Journal of Psychiatry, 161 (Suppl.), 133-139.

    Google Scholar 

  • Lehman, A. F. (1988). Aquality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11, 51-62.

    Google Scholar 

  • Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: Validation of a new alcoholism screening instrument. American Journal of Psychiatry, 131, 1121-1123.

    Google Scholar 

  • Shern, D. L., Wilson, N. Z., & Coen, A. S. (1994). Client outcomes II: Longitudinal client data from the Colorado Treatment Outcome Study. The Milbank Quarterly, 72, 123-148.

    Google Scholar 

  • Shortell, S. M. (1976). Continuity of medical care: Conceptualization and measurement. Medical Care, 14, 377-391.

    Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1990). Structured Clinical Interview for DSM-III-R-Non-Patient Edition (SCID-NP, Version 1.0). Washington DC: American Psychiatric Press.

    Google Scholar 

  • Steinwachs, D. M. (1979). Measuring provider continuity in ambulatory care: An assessment of alternative approaches. Medical Care, 17, 551-565.

    Google Scholar 

  • Sturm, R., Meredith, L. S., & Wells, K. B. (1996). Provider choice and continuity for the treatment of depression. Medical Care, 34, 723-734.

    Google Scholar 

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Chien, C.F., Steinwachs, D.M., Lehman, A. et al. Provider Continuity and Outcomes of Care for Persons with Schizophrenia. Ment Health Serv Res 2, 201–211 (2000). https://doi.org/10.1023/A:1010160419561

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  • DOI: https://doi.org/10.1023/A:1010160419561

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