UCD MentalHealthTrackingInCA

6/18/2012 MENTAL HEALTH TRACKING IN CALIFORNIA Este Geraghty Sergio Aguilar- Gaxiola Marlene von Friederichs-Fitzwater For the Mental Health Services Oversight and Accountability Commission March 24, 2011 Our Charge Use the Medi-Cal billing database to analyze and mmaapp ddiissppaarriittiieess iinn sseerr viiccee aacccceessss aanndd ddeelliivveerryy aatt the local level (census tracts within counties) across the state for various subgroups: † Age † Gender † RRace † Ethnicity 1 6/18/2012 Focus on SMI and SED From the Federal Register: ""…, adults with a seriious mentall iilllln ess are persons 18 years and older who, at any time during a given year, had a diagnosable mental, behavioral, or emotional disorder that met the criteria of DSM-III-R1 and … that has resulted in ffuncttiio nall ii mpaiirmentt whhiichh subb stt anttiialllly iintterfferes with or limits one or more major life activities.…“ Serious emotional disability (SED) refers to children under the age of 18 Access to Care Penetration rate: a common measure reflecting the pprrooppoorrttiioonn ooff iinnddiiv iiddu aallss iinn aa ggiiv eenn ppoopp ullaattiioonn ((lliikkee aa health plan) that use specialty mental health services in a year No. of Medi-Cal Mental Health Patients* Total Medi-Cal Beneficiaries * Includes managed care, fee for service and Short Doyle. Mental health patients have an ICD-9 code consistent with Serious Mental Illness or Serious Emotional Disability 2 6/18/2012 Delivery and Utilization We characterized service delivery via the utilization rraattee: † Total number of mental visits per mental health Medi- Cal beneficiary † Used outpatient visits only 3 6/18/2012 Distribution of Mental Health Services Classification by Quantiles † 5 categories with 20% of the observations in each category † Nice, even color distribution in the map † But ranges vary widely in the mmaapp ((eessppeecciiaallllyy tthhee hhiigghheesstt range). „ Misleading (CT with 10% not equivalent to one with 60%) „ Maps are not comparable „ Cannot easily see patterns in the data 4 6/18/2012 Distribution of Mental Health Services Issues: • TThh e eye hh as ddiiffffii cullty discerning multiple colors •Most census tracts are too small to see clearly •Our eye is drawn to the bigger/darker census tracts – leads to bias Hot Spot Analysis It’s a method for testing the statistically significant cclluusstteerrss ooff aa vvaarriiaabbllee ((ssuucchh aass tthhee ppeenneettrraattiioonn rraattee)) † There is a difference between an outlier and a hot/cold spot † The analysis value (penetration rate) in a census tract is compared to a designated set of neighboring census tracts defined by distance and/or the number of neighbors ((creatiing a llocall mean)) † The local mean is compared to the overall mean for the dataset (in this case, California) † Areas of intense clustering of high values are hot spots and areas of intense clustering of low values are cold spots 5 6/18/2012 Why are we using Hot Spot Analysis? It answers the right question… † Where is the access to mental health care in California greater or lesser than expected, given the overall Medi- Cal beneficiary population? Maps are more comparable There is less concern about missing important information in small census tracts „ We can now see important patterns in the data Statistical significance provides meaningful information Is this census tract a hot spot? 6 6/18/2012 The penetration rates for all census tracts within a distance of the target tract create a local mean. The local mean is compared to the global (statewide) mean. 7 6/18/2012 Result for Penetration Rates Result for Utilization Rates 8 6/18/2012 Map Comparisons 9 6/18/2012 Interpretation Map Comparisons 10 6/18/2012 Next Steps Understanding service access without understanding mmeennttaall hheeaalltthh nneeeedd oonnllyy tteellllss aa ppaarrtt ooff tthhee ssttoorryy Need can be determined in CA using data from the California Health Interview Survey (CHIS) † UCD and UCLA collaboration to create an assessment of need* † Kessler-6 is a tested and robust indicator of severe psychological stress † Sheehan Disability Scale captures impairment due to emotional or mental health † There is potential to map the CHIS data for CA *Padilla-Frausto I, Grant D, Aguilar-Gaxiola S. “Assessing Adult Mental Health Needs In California Using the California Health Interview Survey (CHIS).” Report for the MHSOAC, 11/2010. Summary Hot spot analysis provides an opportunity to see ssttaattiissttiiccaalllly ssiiggnniiffiiccaanntt ppaatttteerrnnss iinn llaarrggee ddaattaasseettss which may help guide resource allocation and track change over time Access to care and utilization could be refined to show how the population receiving services compares to the population in need 11 6/18/2012 Questions? 12