This study will examine access and quality in geriatric depression care, and identify disparities and the factors that lead to them, building knowledge of care processes that is needed to improve care and reduce disparities. We will integrate analyses from multiple CMS datasets including the Medicare Current Beneficiary Survey (MCBS), Medicare claims-files, and merged Medicare-Medicaid data on dual eligibles to provide a comprehensive picture of patterns and trends in depression care among the U.S. elderly, with a focus on the role of Medicare, and on variations in quality of care. We will analyze predictors and trends in depression care among the elderly through 2004 and examine predictors and trends in duration, intensity and guideline consistency of treatment received. We will examine in detail use, type and duration of mental health services; duration of antidepressant use; and expenditures and payer sources for depression care. Disparities in receipt and quality of care will be examined with the aim of identifying the processes that lead to disparities and policy-modifiable barriers that can be addressed to reduce disparities. We will examine how the incidence, length of stay, cost and predictors of hospitalizations for depression have changed as outpatient treatment has increased; the predictors of appropriate outpatient treatment and specialty mental health care use preceding and following the hospitalization; and patterns of rehospitalization. Implications for Medicare policy will be examined. The understanding of depression care for the elderly Medicare population that will be provided by these analyses will be particularly important in a period in which many changes to Medicare, such as prescription drug benefits, are being implemented and others are being debated. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH060831-07
Application #
7342035
Study Section
Services Research Review Committee (SRV)
Program Officer
Chambers, David A
Project Start
2000-01-01
Project End
2010-01-31
Budget Start
2008-02-01
Budget End
2010-01-31
Support Year
7
Fiscal Year
2008
Total Cost
$374,365
Indirect Cost
Name
Rutgers University
Department
Type
Organized Research Units
DUNS #
001912864
City
New Brunswick
State
NJ
Country
United States
Zip Code
08901
Akincigil, Ayse; Olfson, Mark; Siegel, Michele et al. (2012) Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. Am J Public Health 102:319-28
Akincigil, Ayse; Olfson, Mark; Walkup, James T et al. (2011) Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. J Am Geriatr Soc 59:1042-51
Crystal, Stephen; Gaboda, Dorothy; Lucas, Judith et al. (2010) Assessing medication exposures and outcomes in the frail elderly: assessing research challenges in nursing home pharmacotherapy. Med Care 48:S23-31
West, Joyce C; Wilk, Joshua E; Rae, Donald S et al. (2010) First-year Medicare Part D prescription drug benefits: medication access and continuity among dual eligible psychiatric patients. J Clin Psychiatry 71:400-10
Prince, Jonathan D; Akincigil, Ayse; Hoover, Donald R et al. (2009) Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries. Am J Public Health 99:160-7
Himelhoch, Seth; Brown, Clayton H; Walkup, James et al. (2009) HIV patients with psychiatric disorders are less likely to discontinue HAART. AIDS 23:1735-42
Walkup, James; Wei, Wenhui; Sambamoorthi, Usha et al. (2008) Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression. Psychiatr Q 79:43-53
Hoover, Donald R; Akincigil, Ayse; Prince, Jonathan D et al. (2008) Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992--2002;length of stay and expenditures by facility type. Adm Policy Ment Health 35:231-40
Akincigil, Ayse; Hoover, Donald R; Walkup, James T et al. (2008) Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002. Psychiatr Serv 59:1046-8
Prince, Jonathan D; Akincigil, Ayse; Kalay, Ece et al. (2008) Psychiatric rehospitalization among elderly persons in the United States. Psychiatr Serv 59:1038-45

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