Basics of qualitative research: Grounded theory procedures and techniques

The MOS social support survey.

Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.

Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons. The effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated. Within the category of normal aging, a distinction can be made between usual aging, in which extrinsic factors heighten the effects of aging alone, and successful aging, in which extrinsic factors play a neutral or positive role. Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.

https://science.sciencemag.org/content/sci/237/4811/143.full.pdf

Human aging: usual and successful

Effect of psychosocial treatment on survival of patients with metastatic breast cancer

Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. Prior to capitation, one was rated as having greater “readiness” than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less “ready” consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later, these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

In collective bargaining, the nurses' definition of a situation might be quite different from that of health service management; thus, their reasons for striking and their assessment of the bargaining issues would not be congruent with those of management.

Collective bargaining by nurses: a comparative analysis of management and employee perceptions.

Background: In 1995 in an effort to control costs, the State of Colorado implemented a pilot capitated payment system for individuals eligible for public financing of their mental health services. Contracts were with both Not-For-Profit (NFP) firms and For-Profit (FP) firms; the remainder were in the fee-for-service system (FFS). Pharmaceuticals were not included in the capitation rate. However, antipsychotic medications were included in the formularies for consumers who received their medical care through a Health Maintenance Organization (HMO). Aims: This paper examines the use of antipsychotic medication compared to the use of atypical antipsychotics among consumers who are (i) enrolled in a medical HMO or not enrolled in a medical HMO and (ii) whose mental health services are reimbursed on a feefor-service basis (FFS) or through a capitated system. Methods: Data for this study were collected between 1995 and 1997 as part of the Colorado’s Medicaid Mental Health Capitation Pilot Program. Atypical antipsychotics included in the study are: clozapine, risperidone, and olanzapine. The sample of this study consisted of 282 individuals diagnosed with schizophrenia. Results: The utilization of antipsychotics was lower among consumers in HMOs. Compared to consumers in FFS areas of the state, the utilization of atypical antipsychotics was higher in capitated areas of the state. Discussion: There was a strong incentive for the utilization of atypical antipsychotics to increase in capitated systems, unless consumers received their medication prescriptions through an HMO. Limitations include differences in observable and unobservable characteristics among the FFS, DC and MBHO areas, unavoidable selection bias and the small number of HMO enrollees. Conclusions: Capitation of mental health services provides incentives for more cost-effective treatments. HMO enrollment was not a crucial factor to determine access to atypical antipsychotic prescriptions.

/pdf/use-of-antipsychotic-medications-in-treating-schizophrenia-2wydk2qat5.pdf

Use of antipsychotic medications in treating schizophrenia among different financing and delivery systems.

BACKGROUND One of five persons over the age of 65 experiences a diagnosable form of mental illness. Yet their access to and use of specialty services are the lowest among all age groups. It is unclear how managed behavioral healthcare has affected this problematic situation. The Colorado Medicaid Mental Health Capitation Pilot Program, implemented in 1995, provided an opportunity to investigate the impact of managed behavioral healthcare on older Medicaid beneficiaries. STUDY AIMS This study compared two capitated administrative models of Medicaid mental health service delivery to a traditional fee-for-service model, and specifically focused on how these models shaped service use and expenditure patterns for Medicaid beneficiaries over the age of 65. METHODS This study employed a quasi-experimental, pre-post design with a non-equivalent comparison group that reflects the implementation of capitation financing in some parts of Colorado and not others. A difference in difference specification was used to identify the effects of capitation under two administrative models relative to areas remaining under fee-for-service reimbursement. Logistic and Ordinary Least Squares regression were used to estimate service use and (logged) expenditures per repeat and total number of service users. Generalized corrections for heteroskedasticity and repeated observations were applied. Probabilities and average user expenditures were derived from regression results with a fixed case-mix and compared to actuals. RESULTS The analyses indicated that one of the capitated administrative models increased the total number of older beneficiaries who used services while the total number of service users decreased in the other capitated models. Both capitated models reduced repeat use and expenditures for specialty mental health services relative to the traditional FFS model. DISCUSSION Capitation had the expected effect of reducing the duration and intensity of treatment. Clear differences between the two capitated administrative models emerged that appeared consistent with their management philosophies. Measured effects were limited to services covered by capitation and may have been influenced by the observational design. Overall results were somewhat different from those pertaining to younger populations studied in Colorado. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE While capitation clearly reduced total expenditures for older beneficiaries, its influence on specific treatment process measures such as user expenditures, repeat users and total users may vary considerably across treatment systems. Notably, capitation may result in increases or decreases in total users within a specific sub-population such as elders. IMPLICATIONS FOR HEALTH POLICIES This analysis provides critical information for those state mental health and Medicaid agencies that are expanding the application of managed behavioral healthcare within a demographic environment where the population of older adults with mental illnesses is increasing. Financing, organization and their impact on specific treatment populations need to be considered in developing and applying managed behavioral health care. IMPLICATIONS FOR FURTHER RESEARCH The differential effects on elders by administrative models needs further explication and should be measured against clinical and social outcomes as well as the effect of other sources of financing and service substitution.

Joan R. Bloom

Papers

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

Collective bargaining by nurses: a comparative analysis of management and employee perceptions.

Use of antipsychotic medications in treating schizophrenia among different financing and delivery systems.

The implementation of managed behavioral healthcare in Colorado and the effects on older Medicaid beneficiaries.

A tale of two methods: randomization versus matching trials in clinical research.