While there is growing interest in the implementation of value-based payment (VBP) policies in Medicaid, there is little evidence on whether their impacts among high-need beneficiaries vary by race and ethnicity. We conducted a retrospective cohort study using Oregon Medicaid data and a pre-experimental, treatment-only repeated cross-sectional panel design, to examine whether the association of Oregon's Medicaid VBP policy with quality varied by race and ethnicity among the state's beneficiaries with serious mental illness (SMI), that is, those diagnosed with schizophrenia, bipolar disorder, or severe major depressive disorder. We estimated changes in 12 quality measures, by race and ethnicity, pre (2010-2012) and post (2013-2019) VBP implementation. Seven of the 12 measures were designated as VBP performance metrics, with Follow-up after Hospitalization for Mental Illness, 7-day (FUH-7-day), also designated as a bonus-earning incentive metric. The cohort totaled 232,791 person-years (71,599 beneficiaries), with 89% self-described as White and the balance as Latinamerican or Black. The policy was associated with improved quality on FUH-7-day and FUH-30-day, and decreased quality on three physical healthcare measures. The quality impacts varied by race and ethnicity. The policy was associated with the elimination of a pre-existing schizophrenia-only Latinamerican-White FUH-7-day disparity due to the relatively larger Latinamerican post-VBP increase of 18.4 percentage points (95% CI, 2.2-34.6). However, the minority-White disparities in the Antidepressant Medication Management measures persisted post-VBP, and pre-existing advantages for Latinamerican beneficiaries in Cervical Cancer Screening and Avoidance of All-Cause Readmission disappeared because Latinamerican beneficiaries' performance worsened post-VBP. This study of Oregon's mature VBP policy contributes first evidence of the potential impacts of Medicaid VBP policies on quality disparities among beneficiaries with SMI. Findings suggest modest gains, potentially related to targeted financial incentives, while also revealing a potential for stagnant or worsening performance.
This study aimed to examine how urban–rural differences affect the distribution of National Health Service Corps (NHSC) mental health providers. We used the 2022–2023 county-level Area Health Resources File (AHRF), which provides county, state, and national information on health professionals, facilities, population demographics, hospital expenditures, utilization, and environmental factors. Samples were restricted to counties designated as “Whole-County Mental Health Professional Shortage Areas” (MHPSAs). The dependent variable was the number of full-time equivalent (FTE) NHSC mental health providers in the county. The key independent variable was each county’s rural or urban designation, based on the AHRF’s urban-rural continuum indicators. we estimated a generalized linear model (GLM) with a log link and included the natural log of county population as an offset to estimate per-capita NHSC FTE rates. Rural MHPSAs had significantly higher per-capita rates of NHSC mental health provider FTEs than urban MHPSAs (adjusted IRR = 1.38, p < .001). In addition, counties with higher MHPSA scores had higher per-capita rates of NHSC mental health provider FTEs (adjusted IRR = 2.10, p < .001), after adjusting for covariates. Rural areas are likely to have higher per-capita rates of mental health provider placement through the federal NHSC program, suggesting that rural communities may rely more heavily on the NHSC to support provider availability. These findings indicate that the program is an important mechanism for addressing rural mental health workforce shortages, although additional policy efforts are still needed to meet the unique needs of rural communities. Keywords: National Health Service Corps; Mental health workforce; Mental Health Professional Shortage Areas; Urban–rural differences
To document the availability and quality of mental health measures in regularly collected national surveys in the United States. We conducted a review of the mental health measures included in eight publicly available health-focused recurring surveys capable of producing nationally-representative estimates. For each measure, we documented the constructs measured, number of items in the measure, the populations for whom the measure is collected, and the years in which the measure was collected. We examined peer-reviewed literature for psychometric properties of the measures. U.S. national surveys vary substantially in their measurement of mental health constructs in terms of the number of constructs (3-15), measure complexity (1 item - 233 items), populations covered, years administered, and the proportion of constructs that have validated measures (0%-100%). The Medical Expenditure Panel Survey offered the best mix of mental health measures (9; 56% validated), years covered (1996-Present), and related health information; however, each of the surveys offered distinct advantages in terms of the geographic information available (e.g., national, state, census tract), populations covered (e.g., children, teens, and/or adults) and measured mental health constructs (conditions, the impact of those conditions, and mental health service use). Mental health is measured in various ways across the nationally-representative surveys, with each survey offering distinct advantages and disadvantages. Mental health researchers should consider these differences when using national survey data. Future research should attempt to validate the mental health measures used in these surveys and efforts should be made to address existing gaps in measurement.
Decision-makers in U.S. public behavioral health systems need reliable evidence on effective policies and practices to effectively navigate a landscape characterized by resource constraints and workforce challenges. To identify the highest priority information needs and research priorities of the youth behavioral health field, we engaged 60 research producers and researcher users in an expert consensus process that included two phases: (1) a pre-summit survey and (2) an in-person summit that included a Nominal Group Process (NGP). Participants included academic researchers, state behavioral health and Medicaid decision-makers, youth and family advocacy leaders, federal funders, and providers from 22 states. Results of the survey identified workforce development (41
This mixed methods study investigates aggression in acute psychiatric care, focusing on both incidence and professional reflections across 23 High and Intensive Care wards in the Netherlands. Using a sequential explanatory design, quantitative data on aggressive incidents were collected over 12 months and followed by qualitative focus groups with nurses and team leaders. Aggression, predominantly physical and often targeting staff, was frequently reported, while the cause of incidents was unknown in 31.6
