The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Inclusion Criteria
2.3. Exclusion Criteria
2.4. Description of Measures
2.5. Independent Variable
2.6. Dependent Variable
2.7. Analytical Method
3. Results
Result of the Average Proportional Change in the Number of Acute Inpatient Admissions
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Virginia | North Carolina | p-Value | |
---|---|---|---|
Total number of acute inpatient admissions for mental illness and SUD | 713,513 | 1,092,067 | <0.000 |
Total number of acute inpatient admissions for mental illness (%) | 624,832 (87.6) | 955,590 (87.5) | <0.000 |
Total number of acute inpatient admissions for SUD (%) | 254,514 (35.7) | 385,166 (32.3) | <0.000 |
Average age of admissions (years) (SD) | 44.38 (1.7) | 44.40 (1.3) | 0.554 |
Average length of hospital stays (days) (SD) | 4.30 (0.5) | 4.67 (0.4) | <0.000 |
Average percentage of uninsured patients younger than 65 years old (SD) | 10.24 (2.2) | 13.10 (2.2) | <0.000 |
Virginia | Pre-ARTS (5 Quarters) | Between ARTS and Medicaid Expansion (7 Quarters) | Post-Medicaid Expansion (4 Quarters) |
---|---|---|---|
Total admissions (N) | 797 | 788 | 780 |
All behavioral health acute inpatient admissions (%) | 334 (41.9) | 335 (42.5) | 337 (43.2) |
Mental illness acute inpatient admissions (%) | 293 (36.8) | 293 (37.2) | 295 (37.8) |
SUD acute inpatient admissions (%) | 117 (14.7) | 119 (15.1) | 123 (15.8) |
North Carolina | |||
Total admissions | 1326 | 1320 | 1318 |
All behavioral health acute inpatient admissions (%) | 666 (49.1) | 685 (51.9) | 700 (53.1) |
Mental illness acute inpatient admissions (%) | 582 (43.9) | 599 (45.4) | 613 (46.5) |
SUD acute inpatient admissions (%) | 234 (17.7) | 241 (18.3) | 249 (18.9) |
VA/Year–Quarter | All Behavioral Health Acute Inpatient Admissions 95% (CI) | Mental Illness Acute Inpatient Admissions 95% (CI) | SUD Acute Inpatient Admissions 95% (CI) |
---|---|---|---|
2016Q1 | 1.2 (−1.7, 4.0) | 1.2 (−1.8, 4.2) | 0.7 (−3.5, 4.9) |
2016Q2 | 0.7 (−2.6, 4.1) | 0.5 (−3.1, 4.1) | −1.0 (−5.8, 3.8) |
2016Q3 | −0.6 (−3.4, 2.2) | −1.1 (−4.1, 1.8) | 0.6 (−3.3, 4.5) |
2016Q4 | 0.3 (−2.4, 2.9) | 1.0 (−2.6, 2.8) | −0.4 (−4.5, 3.8) |
2017Q1 | −0.6 (−2.7, 1.7) | −0.5 (−2.8, 1.8) | −1.7 (−5.4, 2.0) |
2017Q2 | Reference | Reference | Reference |
2017Q3 | −0.7 (−2.6, 1.1) | −1.7 (−3.7, 0.3) | 1.5 (−1.5, 4.5) |
2017Q4 | −1.8 (−3.7, 0) | −2.3 * (−4.4, −0.2) | −0.8 (−4.0, 2.4) |
2018 Q1 | −2.6 * (−5.1, −0.2) | −3.0 * (−5.4, −0.4) | −1.8 (−6.2, 2.5) |
2018Q2 | −2.8 * (−5.3, −0.2) | −3.5 * (−6.3, −0.8) | −3.2 (−7.2, 0.8) |
2018Q3 | −4.2 ** (−5.3, −0.2) | −4.7 ** (−7.5, −1.9) | −2.9 (−7.4, 1.6) |
2018Q4 | −4.9 *** (−7.5, −2.4) | −5.3 *** (−8.2, −2.4) | −4.0 (−8.5, 0.6) |
2019Q1 | −1.7 (−5.1, 1.7) | −1.9 (−5.4, 1.6) | 1.3 (−4.5, 7.2) |
2019Q2 | −3.4 (−6.9, 0.2) | −4.0 (−7.7, −0.3) | 0.5 (−5.6, 6.5) |
2019Q3 | −2.5 (−6.0, 1.0) | −2.8 (−6.4, 0.9) | 1.3 (−4.5, 7.1) |
2019Q4 | −3.8 * (−7.6, −0.0) | −4.6 * (−8.5, −0.7) | −0.2 (−5.8, 5.3) |
Behavioral Health Acute Inpatient Admissions | p-Value | Mental Illness Acute Inpatient Admissions | p-Value | Substance Use Disorder Acute Inpatient Admissions | p-Value | |
---|---|---|---|---|---|---|
After ARTS, before Medicaid expansion (7 quarters), 95% (CI) | −2.5 (−4.1, −0.8) | 0.003 | −2.9 (−4.7, −1.2) | 0.001 | −1.6 (−4.4, 1.2) | 0.256 |
After Medicaid expansion (4 quarters), 95% (CI) | −2.9 (−6.1, 0.4) | 0.089 | −3.33 (−6.8, 0.1) | 0.057 | 0.7 (−4.6, 6.1) | 0.792 |
Difference, 95% (CI) | 0.4 (−1.9, 2.7) | 0.735 | 0.41 (−2.0, 2.8) | 0.735 | −2.3 (−5.8, 1.2) | 0.195 |
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Salehian, S.; Cunningham, P.; Barnes, A.; Lee, S.-Y.D. The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid. Int. J. Environ. Res. Public Health 2024, 21, 777. https://doi.org/10.3390/ijerph21060777
Salehian S, Cunningham P, Barnes A, Lee S-YD. The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid. International Journal of Environmental Research and Public Health. 2024; 21(6):777. https://doi.org/10.3390/ijerph21060777
Chicago/Turabian StyleSalehian, Shiva, Peter Cunningham, Andrew Barnes, and Shoou-Yih Daniel Lee. 2024. "The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid" International Journal of Environmental Research and Public Health 21, no. 6: 777. https://doi.org/10.3390/ijerph21060777