Dataset Information

Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.

ABSTRACT: Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective.We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank sum, and t tests were used to test for statistical differences in outcomes between adolescents on the basis of screening status.Of the 4010 adolescents who completed depression screening, 3707 (92.4%) screened negative (PHQ-2 <2 or PHQ-9 <10), 186 (3.9%) screened positive for mild depression (PHQ-9 10-14), and 95 (2.4%) screened positive for moderate to severe depression (PHQ-9 ?15). In the 12 months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and they had significantly higher utilization of outpatient medical (mean ± SD, 8.3 ± 1.5 vs 3.5 ± 5.1) and mental health (3.8 ± 9.3 vs 0.7 ± 3.5) visits. Total health care system costs for screen-positive adolescents ($5083 ± $10,489) were more than twice as high as those of screen-negative adolescents ($2357 ± $7621).Adolescent depressive symptoms, even when mild, are associated with increased health care utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control health care costs among screen-positive adolescents.

SUBMITTER: Wright DR

PROVIDER: S-EPMC4715622 | biostudies-literature | 2016 Jan-Feb

REPOSITORIES: biostudies-literature

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Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.

Wright Davene R DR Katon Wayne J WJ Ludman Evette E McCauley Elizabeth E Oliver Malia M Lindenbaum Jeffrey J Richardson Laura P LP

Academic pediatrics 20151009 1

<h4>Objective</h4>Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective.<h4>Methods</h4>We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were ...[more]

PMID: 26456002

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Project description:ImportanceMeasuring health care utilization and costs before death has the potential to initiate health care improvement.ObjectiveTo examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system.Design, setting, and participantsThis population-based cohort included 966?436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative and census data. Data for deaths from 2005 to 2013 were analyzed from November 1, 2016, through January 31, 2017. Analyses were updated from May 1, 2019, to June 15, 2019, to include deaths from 2014 and 2015.ExposuresSociodemographic exposures included age, sex, and neighborhood income quintiles, which were obtained by linking decedents' postal codes to census data. Aggregated Diagnosis Groups were used as a general health service morbidity-resource measure.Main outcomes and measuresHealth care services accessed for the last 2 years of life, including acute hospitalization episodes of care, intensive care unit visits, and emergency department visits. Total health care costs were calculated using a person-centered costing approach. The association of area-level income with high resource use 1 year before death was analyzed with Poisson regression analysis, controlling for age, sex, and Aggregated Diagnosis Groups.ResultsAmong 966?436 decedents (483?038 [50.0%] men; mean [SD] age, 76.4 [14.96] years; 231?634 [24.0%] living in the lowest neighborhood income quintile), health care expenditures increased in the last 2 years of life during the study period (CAD$5.12 billion [US $3.83 billion] in 2005 vs CAD$7.84 billion [US $5.86 billion] in 2015). In the year before death, 758?770 decedents (78.5%) had at least 1 hospitalization episode of care, 266?987 (27.6%) had at least 1 intensive care unit admission, and 856?026 (88.6%) had at least 1 emergency department visit. Overall, deaths in hospital decreased from 37?984 (45.6%) in 2005 to 39?474 (41.5%) in 2015. Utilization in the last 2 years, 1 year, 180 days, and 30 days of life varied by resource utilization gradients. For example, the proportion of individuals visiting the emergency department was slightly higher among the top 5% of health care users compared with other utilization groups in the last 2 years of life (top 5%, 45?535 [94.2%]; top 6%-50%, 401?022 [92.2%]; bottom 50%, 409?469 [84.7%]) and 1 year of life (top 5%, 43?007 [89.0%]; top 6%-50%, 381?732 [87.8%]; bottom 50%, 380?859 [78.8%]); however, in the last 30 days of life, more than half of individuals in the top 6% to top 50% (223?262 [51.3%]) and bottom 50% (288?480 [59.7%]) visited an emergency department, compared with approximately one-third of individuals in the top 5% (16?916 [35.0%]). No meaningful associations were observed in high resource use between individuals in the highest income quintile compared with the lowest income quintile (rate ratio, 1.02; 95% CI, 0.99-1.05) after adjusting for relevant covariates.Conclusions and relevanceIn this study, health care use and spending in the last 2 years of life in Ontario were high. These findings highlight a trend in hospital-centered care before death in a single-payer health system.

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Dataset Information

Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.

Publications

Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.

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