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Open Access Publications from the University of California

Scholarly Works (6 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2020)

Background: In 2016, close to 45 million adults in the United States had some form of mental illness, but only 43% received treatment for their condition. This unmet need for mental health (MH) services has been attributed to the cost of care or insufficient insurance coverage. Research has also shown that patients with comorbid MH and medical conditions are at a higher risk for health complications and are frequently high utilizers of health services. Research Objective: I aimed to assess the potential benefits of MH staffing within health centers (HCs) funded by HRSA, a crucial part of the safety net which provides primary care services regardless of patients’ ability to pay. My research questions are whether licensed MH staffing within a patient’s HC is associated with higher likelihood of MH service utilization (paper 1) and lower likelihood of high utilization of outpatient and acute care services (paper 2). Data and Sample: In the first study I use data from HRSA’s 2014 Health Center Patient Survey and administrative data on patients’ HCs from the UDS 2013 report. The study sample included 4,575 patients aged 18-64 who identified their HC as their usual source of care. In the second study, I use patient level encounter data from California’s Low-Income Health Program (LIHP) from 2011-2013, and administrative data on patients’ HCs from California’s OSHPD 2012 Primary Care Utilization report. This study sample included 26,833 patients between the ages of 19-64, enrolled in LIHP and assigned to an HC as their medical home. Results: My first research paper showed that more overall licensed MH staffing at HCs (versus none) increased the likelihood of patients receiving MH treatment anywhere and on-site (at the patient’s HC), and any level of psychiatrist staffing also increased the likelihood of receiving MH treatment on-site. My second study showed that licensed MH staffing of at least 0.5 FTE (versus none) was associated with high patient utilization of outpatient visits. I also found that any level of psychiatrist staffing (versus none) increased the likelihood of having three or more ED visits, and any level of LCSW staffing decreased the likelihood of 3 or more ED visits and any hospitalization. Discussion: Access to MH services for low-income populations continues to be a challenge in the United States. Due to the strategic location of HCs in medically under-served areas, co-locating an adequate number of licensed MH providers at HCs is likely to help reduce disparities in access to MH services. Staffing levels for specific types of providers in these studies may have been too low to help reduce high utilization of services. More research is needed on the role of specific types of MH providers and the necessary level of FTE to adequately meet patient needs.

    Cover page: The Role of Licensed Mental Health Staffing in Improving Patient Outcomes at Health Centers
    • Article
    • Peer Reviewed
    Recent Work (2017)

    Federally Qualified Health Centers--commonly referred to as Community Health Centers (CHCs)--serve as critical safety net providers for those who are uninsured or who may become uninsured. This policy brief reports the findings from the Remaining Uninsured Access to Community Health Centers (REACH) research project, which sought to identify the impact of the Affordable Care Act (ACA) on the ability of CHCs to serve the remaining uninsured. We examined strategies undertaken by CHCs in four states to reinforce the local safety net through partnerships, improvements to the local health system, and advocacy. With the uncertainties about whether Medicaid expansion will be continued or will be handed over to the states with limited oversight, partnerships both among CHCs and between CHCs and others in the health care system and beyond may become even more important.

      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2018)
      We examined the impact of Medicaid expansion on rates of the remaining uninsured at the federally qualified health center level by race/ethnicity, limited English proficiency, and poverty status of their patients. Results indicated a systematic disadvantage in nonexpansion states for federally qualified health centers with high concentrations of these populations and an advantage in expansion states for federally qualified health centers with fewer limited English proficiency patients. Our findings highlight the importance of maintaining the Affordable Care Act in reducing disparities in coverage and the importance of federal funding to continue services for the remaining uninsured and vulnerable populations in both expansion and nonexpansion states.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2022)
        Primary care telephone access has been associated with patient satisfaction and emergency department utilization even after accounting for objective appointment wait times. However, relatively little is known about how to best structure and manage telephone access in primary care. Assess how primary care telephone access is structured and managed and explore how variation in telephone management may affect primary care teams and patients. We used 2016 administrative and patient survey data to select six Veterans Administration medical centers (VAMCs) with above-average primary care access (time to third next available appointment) but variable patient-reported access, geographic region, and urbanicity. Semi-structured interviews were conducted August -October 2017. Forty-three key stakeholders knowledgeable about primary care, telephone management, and operational priorities nationally and/or within each VAMC. Telephone access was organized and managed differently across sites. Regional call centers were perceived as more efficient but less flexible in tailoring processes to meet local needs. Patient preferences for speaking with their own care teams were cited as a reason to manage telephone access locally rather than regionally, particularly in rural sites. Sites with high patient-rated access described call center functions as well-integrated with primary care team workflow, while those with low patient-rated access perceived telephone management practices as negatively affecting primary care team workload. Call center understaffing was a major barrier to optimal telephone access in all six sites, though rural sites reported greater challenges with provider recruitment and retention. In VA, efforts to improve telephone access have focused on centralizing call center operations but current call center performance metrics do not account for the extent to which call center functions are integrated with primary care workflows or may impact patient experience. Efforts to improve primary care access should carefully consider impact of telephone management practices on providers and patients.
          Cover page: Telephone Access Management in Primary Care: Cross-Case Analysis of High-Performing Primary Care Access SitesCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2017)
          Federally Qualified Health Centers--commonly referred to as Community Health Centers (CHCs)--serve as critical safety net providers for those who are uninsured or who may become uninsured. This policy brief reports the findings from the Remaining Uninsured Access to Community Health Centers (REACH) research project, which sought to identify the impact of the Affordable Care Act (ACA) on the ability of CHCs to serve the remaining uninsured. We examined strategies undertaken by CHCs in four states to reinforce the local safety net through partnerships, improvements to the local health system, and advocacy. With the uncertainties about whether Medicaid expansion will be continued or will be handed over to the states with limited oversight, partnerships both among CHCs and between CHCs and others in the health care system and beyond may become even more important.
            Creative Commons 'BY-NC-SA' version 4.0 license
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2021)

            Objective

            The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment.

            Methods

            Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64.

            Results

            Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%).

            Conclusions

            Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.
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