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theses

Behavioral health disorders, comprising mental illness and behavioral health disorders, are common among adults, especially those with lower socioeconomic status, and frequently co-occur with chronic physical health conditions. Prevalence of behavioral health disorders is twice as high among Medicaid enrollees as in the general population, and of the nearly one-third of Medicaid enrollees with mental illness, more than half also have chronic medical comorbidity. It is important, thus, to identify how to provide high-quality care for this population.
Patients with behavioral health disorders often first present to primary care, and nearly one-third of adults who have a mental health visit seek care solely in primary care settings. Primary care practices provide a key opportunity to address critical patient needs but often struggle to manage these patients. Integration of behavioral health services in primary care settings along with continuity of care with primary care providers are aspects of care provision that present an opportunity to improve care. While shown to generally achieve positive clinical outcomes and reduce cost, there is lack of research on how these aspects of primary care practices might improve care for patients with behavioral health and other chronic medical comorbidities seeking care in primary care.
Focusing on New Jersey (NJ), this study examines state-wide data to analyze how provider effort to locally integrate care relates to utilization of costly inpatient services for low-resource patients across diverse primary care practices. We will specifically look at whether primary care practice efforts to co-locate behavioral health providers, such as psychiatrists, or psychologists, improves care for NJ Medicaid enrollees with behavioral health and other chronic conditions. Additionally, this dissertation will also investigate how continuity of care with primary care providers relates to use of hospital services along with Medicaid spending for patients with behavioral health and chronic physical conditions. Overall, I hope to shed light on how to improve care in primary care settings for patients with behavioral health disorders and other chronic comorbidities.

ETD_10369

Ph.D.

Includes bibliographical references

doi:10.7282/t3-ewn5-py31

ETD doctoral

The author owns the copyright to this work.