Abstract
Patterns of behavioral health service utilization were examined among youth diagnosed with bipolar disorder (n = 832). Youth were categorized as high, moderate, and low restrictive service users (43, 7, and 50%, respectively). Factors associated with receiving care in highly restrictive settings included: numerous co-occurring diagnoses and being enrolled in managed care. Youth with regular outpatient visits were less likely to receive care in highly restrictive settings. This analysis provides a broad and dramatic picture of the intensity of services needed by most youth with bipolar. Having regular outpatient services shows promise with regard to reducing costly care in restrictive settings.
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Baldwin, L. M., Klabunde, C. N., Green, P., Barlow, W., & Wright, G. (2006). In search of the perfect comorbidity measure for use with administrative claims data: Does it exist? Medical Care, 44, 745–753.
Biederman, J., Faraone, S. V., Wozniak, J., Mick, E., Kwon, A., Cayton, G. A., et al. (2005). Clinical correlates of bipolar disorder in a large, referred sample of children and adolescents. Journal of Psychiatric Research, 39, 611–622.
Bindman, A. B., Chattopadhyay, A., Osmond, D. H., Huen, W., & Bacchetti, P. (2005). The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions. Health Services Research, 40, 19–38.
Birmaher, B., Axelson, D., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175–183.
Blader, J. C., & Carlson, G. A. (2007). Increased rates of bipolar disorder diagnoses among US child, adolescent, and adult inpatients, 1996–2004. Biological Psychiatry, 62, 107–114.
Blow, F. C., McCarthy, J. F., Valenstein, M., Zeber, J. E., & Gillon, L. (2004). Care for veterans with psychosis in the VHA, FY03: 5th Annual national psychosis registry report. Ann Arbor, MI: Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center.
Broemeling, A., Watson, D., & Black, C. (2008). Chronic conditions and co-morbidity among residents of British Columbia. Centre for Health Service and Policy Research [Announcement posted on the World Wide Web]. March 7, 2007,
Carlsson, L., Strender, L. E., Fridh, G., & Nilsson, G. (2004). Types of morbidity and categories of patients in a Swedish county. Applying the Johns Hopkins Adjusted Clinical Groups System to encounter data in primary health care. Scandinavian Journal of Primary Health Care, 22, 174–179.
Evans-Lacko, S. E., Zeber, J. E., Gonzalez, J. M., & Olvera, R. L. (2009). Medical comorbidity among youth diagnosed with bipolar disorder in the United States. Journal of Clinical Psychiatry [Epub ahead of print].
Gadomski, A., Jenkins, P., & Nichols, M. (1998). Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics, 101, E1.
Goldman, W., McCulloch, J., & Sturm, R. (1998). Costs and use of mental health services before and after managed care. Health Affairs (Millwood.), 17, 40–52.
Goodwin, F., & Jamison, K. (2007). Manic-depressive illness. New York: Oxford University Press.
Jerrell, J. M., & Prewette, E. D. (2008). Outcomes for youths with early- and very-early-onset bipolar I disorder. The Journal of Behavioral Health Services and Research, 35, 52–59.
Jolin, E. M., Weller, E. B., & Weller, R. A. (2005). Prepubertal bipolar disorder: Proper diagnosis should lead to better treatment response. Current Psychiatry Reports, 7, 104–111.
Kaestner, R., Joyce, T., & Racine, A. (2001). Medicaid eligibility and the incidence of ambulatory care sensitive hospitalizations for children. Social Science and Medicine, 52, 305–313.
Kashner, T. M. (1998). Agreement between administrative files and written medical records: A case of the Department of Veterans Affairs. Medical Care, 36, 1324–1336.
Leibowitz, A., Manning, W. G., Jr., Keeler, E. B., Duan, N., Lohr, K. N., & Newhouse, J. P. (1985). Effect of cost-sharing on the use of medical services by children: Interim results from a randomized controlled trial. Pediatrics, 75, 942–951.
Logan, J. E., Riley, A. W., & Barker, L. E. (2008). Parental mental and pain-related health and pediatric ambulatory care sensitive emergency department visits and hospitalizations. Health Services Research, 43, 656–674.
Lurie, N., Popkin, M., Dysken, M., Moscovice, I., & Finch, M. (1992). Accuracy of diagnoses of schizophrenia in Medicaid claims. Hospital & Community Psychiatry, 43, 69–71.
Martin, A., & Leslie, D. (2003). Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997–2000. American Journal of Psychiatry, 160, 757–764.
Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A. B., & Olfson, M. (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64, 1032–1039.
Peele, P. B., Axelson, D. A., Xu, Y., & Malley, E. E. (2004). Use of medical and behavioral health services by adolescents with bipolar disorder. Psychiatric Services, 55, 1392–1396.
Pollack, H. A., Wheeler, J. R., Cowan, A., & Freed, G. L. (2007). The impact of managed care enrollment on emergency department use among children with special health care needs. Medical Care, 45, 139–145.
Reid, R. J., MacWilliam, L., Verhulst, L., Roos, N., & Atkinson, M. (2001). Performance of the ACG case-mix system in two Canadian provinces. Medical Care, 39, 86–99.
Rizzo, C. J., Esposito-Smythers, C., Swenson, L., Birmaher, B., Ryan, N., Strober, M., et al. (2007). Factors associated with mental health service utilization among bipolar youth. Bipolar Disorders, 9, 839–850.
Rosen, A. K., Loveland, S., Anderson, J. J., Rothendler, J. A., Hankin, C. S., Rakovski, C. C., et al. (2001). Evaluating diagnosis-based case-mix measures: How well do they apply to the VA population? Medical Care, 39, 692–704.
Ruger, J. P., Richter, C. J., & Lewis, L. M. (2006). Clinical and economic factors associated with ambulance use to the emergency department. Academic Emergency Medicine, 13, 879–885.
Schapiro, N. A. (2005). Bipolar disorders in children and adolescents. Journal of Pediatric Health Care, 19, 131–141.
Simon, G. E., & Unutzer, J. (1999). Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatric Services, 50, 1303–1308.
Starfield, B. (2006). Threads and yarns: Weaving the tapestry of comorbidity. The Annals of Family Medicine, 4, 101–103.
Unutzer, J., Simon, G., Pabiniak, C., Bond, K., & Katon, W. (2000). The use of administrative data to assess quality of care for bipolar disorder in a large staff model HMO. General Hospital Psychiatry, 22, 1–10.
US Department of Health and Human Services. (1999). Mental health: A report of the surgeon general.
US Department of Health, Human Services. (2004). Area resource file (ARF). Rockville, MD: Health Resources and Services Administration.
Weiner, J. (2001). The Johns Hopkins ACG Case-Mix System™: Documentation & application manual.
Weiner, J. P., Dobson, A., Maxwell, S. L., Coleman, K., Starfield, B., & Anderson, G. F. (1996). Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financing Review, 17, 77–99.
Weiner, J. P., Starfield, B. H., Steinwachs, D. M., & Mumford, L. M. (1991). Development and application of a population-oriented measure of ambulatory care case-mix. Medical Care, 29, 452–472.
Wennberg, J. E. (2004). Practice variation: Implications for our health care system. Managed Care, 13, 3–7.
Wennberg, J., & Gittelsohn, A. (1982). Variations in medical care among small areas. Scientific American, 246, 120–134.
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We are grateful to the NIMH for their funding support (T32 MH 19545), and to Thomson/Medstat for providing data.
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Evans-Lacko, S.E., Spencer, C.S., Logan, J.E. et al. Patterns and Predictors of Restrictive Health Care Service Use by Youths with Bipolar Disorder. Adm Policy Ment Health 37, 379–387 (2010). https://doi.org/10.1007/s10488-009-0248-5
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DOI: https://doi.org/10.1007/s10488-009-0248-5