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What was your research question? Why did you choose that question?
Primary care is filling critical capacity gaps and playing a larger role in addressing mental and behavioral health disorders. This work is a part of the TEAM UP Scaling and Sustainability Center (Transforming and Expanding Access to Mental Health Care Universally in Pediatrics), which partners with primary care practices to integrate a comprehensive behavioral health model into pediatric primary care to promote healthy child development, early identification of emerging issues, and quick access to necessary care. As background for this work in Massachusetts, we sought to better understand the role primary care providers have played in treating child and adolescent mental and behavioral health disorders since 2014, and to quantify changes in types of mental and behavioral health disorders being treated in primary care settings.
Which CHIA data did you use?
We used the 2014-2023 MA APCD, which was linked to Massachusetts Registration of Provider Organizations (RPO) files to identify primary care practices and providers.
What was your experience using CHIA data?
The MA APCD is a complex database. Over the last 9 years, our research team has iteratively added to our analytic data file as new years of data become available. We’ve learned a lot along the way. For example, in creating our analytic datasets from the raw claims files, our team has developed algorithms to attribute enrollees to primary care practices, which has involved extensive revision over time as provider directories evolve and as organizational billing changes affect our ability to consistently identify the same practices within the claims. In “sewing” together new extracts, we have navigated using member ID crosswalks in a way that allows for tracking individual patients across data extracts, while we’ve also had to make strategic decisions about which extract to pull data from when we have duplicate years available from different extracts (as the data often differs).
We ultimately collapse the raw data into person-quarter data files, where for every quarter of the year during which a child is enrolled in health insurance, we summarize all health care utilization occurring in that quarter. To date, through this process, we have built a longitudinal analytic dataset comprised of over 89 million person-quarters among children ages 0-21 in the state, which we use to support our pediatric mental and behavioral health work. CHIA staff have been a fantastic resource as we navigate ongoing data questions across this work.
Please briefly describe your research and key findings.
We used a subset of our full analytic sample to identify children ages 1-18, who resided in Massachusetts, with 90 or more days of Medicaid or private insurance enrollment in any quarter, resulting in 37,659,240 person-quarters (representing 1,848,249 unique children in the state). Among this pediatric sample, we calculated adjusted quarter-over-quarter trends in the statewide rate of all-cause primary care visits, the rate of mental health-related primary care visits, the percentage of primary care visits with a mental health diagnosis, and the percentage of primary care visits with a diagnosis for attention deficit/hyperactivity disorder (ADHD), anxiety, depression, autism spectrum disorder (ASD), and trauma- or stressor-related disorders (PTSD).
We found that the rate of pediatric primary care visits decreased slightly over the 10-year period, from 58.9 visits per 100 children in 2014 to 54.8 visits per 100 children in 2023, while the rate of mental health-related primary care visits increased, from 5.9 visits per 100 children in 2014 to 9.7 visits per 100 in 2023. The percentage of pediatric primary care visits with any mental health diagnosis increased from 9.3% in 2014 to 16.2% in 2023, driven primarily by anxiety and ASD visits.
Which findings were particularly interesting or surprising for you?
Overall, over this 10-year period, we found a 74% relative increase in primary care visits with a mental health diagnosis, driven by 300% relative increases in both anxiety and ASD visits. This highlights both the growing prevalence of mental health conditions among children and the increasing role of primary care providers in recognizing and addressing those needs.
What "takeaway" information would you like to highlight from your research and/or experience using our data?
The MA APCD is an incredibly valuable resource for understanding the landscape of pediatric mental and behavioral health across the state, particularly in its ability to capture nearly all children in Massachusetts over a longitudinal time span, while having the ability to link to external directories to identify provider practices. In this particular study, the rapid rise of mental health needs that are presenting to pediatric primary care settings across Massachusetts suggest real need to equip pediatric primary care practices with the training, staffing, and resources needed to effectively address mental health needs of children and adolescents. One way to do so is through expansion of comprehensive integrated pediatric behavioral health models, like TEAM UP, which we will continue to evaluate over time using the MA APCD.
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