TY - JOUR
T1 - Effect of outpatient service utilization on hospitalizations and emergency visits among youths with autism spectrum disorder
AU - Mandell, David S.
AU - Candon, Molly K.
AU - Xie, Ming
AU - Marcus, Steven C.
AU - Kennedy-Hendricks, Alene
AU - Epstein, Andrew J.
AU - Barry, Colleen L.
N1 - Funding Information:
Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine (Mandell, Candon, Xie, Marcus), Leonard Davis Institute of Health Economics (Mandell, Candon, Epstein, Barry), and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kennedy-Hendricks, Barry). Send correspondence to Dr. Candon (candon@upenn. edu). This work was funded by the National Institute of Mental Health (R01-MH-096848, Evaluating the Effects of Autism Insurance Mandates). Dr. Marcus reports personal fees from Allergan, Alkermes, Johnson & Johnson, Sage Therapeutics, and Sunovion. Dr. Epstein is a principal at Medicus Economics, L.L.C., a consultancy with clients in the bio-pharmaceutical industry. The other authors report no financial relationships with commercial interests.
Publisher Copyright:
© 2019 American Psychiatric Association. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Objective: Psychiatric hospitalizations and emergency department (ED) visits occur more frequently for youths with autism spectrum disorder (ASD). One mechanism that may reduce the likelihood of these events is utilization of home and community-based care. Using commercial claims data and a rigorous analytical framework, this retrospective study examined whether spending on outpatient services for ASD, including occupational, physical, and speech therapies and other behavioral interventions, reduced the likelihood of psychiatric hospitalizations and ED visits. Methods: The study sample was composed of .100,000 children and young adults with ASD and commercial insurance from every state between 2008 and 2012. The authors estimated maximum-likelihood complementary log-log link survival models with robust standard errors. The outcomes of interest were a hospitalization or an ED visit with an associated psychiatric diagnosis code (ICD-9-CM 290 through 319) in a given week. Results: An increase of $125 in weekly spending on ASD-specific outpatient services in the 7 to 14 weeks prior to a given week reduced the likelihood of a psychiatric hospitalization in that week by 2%. ASD-specific outpatient spending during the 6 weeks prior to a psychiatric hospitalization did not decrease risk of hospitalization. Spending on ASD-specific outpatient services did not reduce the likelihood of a psychiatric ED visit. Conclusions: The financial burden associated with ASD is extensive, and psychiatric hospitalizations remain the most expensive type of care, costing more than $4,000 per week on average. Identifying the mechanisms by which psychiatric hospitalizations occur may reduce the likelihood of these events.
AB - Objective: Psychiatric hospitalizations and emergency department (ED) visits occur more frequently for youths with autism spectrum disorder (ASD). One mechanism that may reduce the likelihood of these events is utilization of home and community-based care. Using commercial claims data and a rigorous analytical framework, this retrospective study examined whether spending on outpatient services for ASD, including occupational, physical, and speech therapies and other behavioral interventions, reduced the likelihood of psychiatric hospitalizations and ED visits. Methods: The study sample was composed of .100,000 children and young adults with ASD and commercial insurance from every state between 2008 and 2012. The authors estimated maximum-likelihood complementary log-log link survival models with robust standard errors. The outcomes of interest were a hospitalization or an ED visit with an associated psychiatric diagnosis code (ICD-9-CM 290 through 319) in a given week. Results: An increase of $125 in weekly spending on ASD-specific outpatient services in the 7 to 14 weeks prior to a given week reduced the likelihood of a psychiatric hospitalization in that week by 2%. ASD-specific outpatient spending during the 6 weeks prior to a psychiatric hospitalization did not decrease risk of hospitalization. Spending on ASD-specific outpatient services did not reduce the likelihood of a psychiatric ED visit. Conclusions: The financial burden associated with ASD is extensive, and psychiatric hospitalizations remain the most expensive type of care, costing more than $4,000 per week on average. Identifying the mechanisms by which psychiatric hospitalizations occur may reduce the likelihood of these events.
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U2 - 10.1176/appi.ps.201800290
DO - 10.1176/appi.ps.201800290
M3 - Article
C2 - 31215353
AN - SCOPUS:85072747280
SN - 1075-2730
VL - 70
SP - 888
EP - 893
JO - Psychiatric Services
JF - Psychiatric Services
IS - 10
ER -