Healthcare for Communities

Key aims: Healthcare for Communities is designed to provide information on how the healthcare system is functioning and changing for people with alcohol, drug abuse and mental health conditions. HCC tracks changes in health policy, health care delivery, access to care, and costs and outcomes of care related to ADM conditions.

Methods: HCC links primary data collected from households, employers, and public agency administrators with secondary data sources. For the household survey, the main component of HCC, we obtained a nationally representative sample (9,585 respondents) with a large percentage of persons with ADM need by conducting a follow-up study of participants in the Community Tracking Study (CTS), but oversampling persons with ADM need or service utilization. For the HCC employer survey, we surveyed employers who were identified as providing healthcare benefits by household survey respondents. The survey collected information on mental health and substance abuse benefits from 875 employers. The public agency administrator survey gathered data on how the states fund, organize and deliver ADM care from 50 state Medicaid agency administrators and 50 state mental health agency commissioners.

Significance: Healthcare for Communities (HCC) was funded under the RWJF Health Tracking Initiative as a bold, new attempt to provide more systematic, relevant, and timely information on ADM care. Initial goals included providing the first, basic national estimates in some areas, such as documenting the level of quality of care provided nationally for common mental disorders; and providing a basic information infrastructure to help inform current policy debates. This kind of integration of clinical and policy relevant issues had not been attempted before on a national scale.

Impact: HCC has yielded many important findings and has had substantial impact through its accomplishments and results. Most significant has been our ability to use current research findings to inform real-time policy debates and inform national policy forums. With special permission from the editor of the Journal of the American Medical Association, we were able to provide our findings to people involved in state and national mental health parity debates before the research was published. Similarly, within a 3-month period, we provided the Surgeon General with national estimates of unmet need for child mental health care. Our research has highlighted many of the issues and problems associated with ADM care, including what populations are at greatest risk, what are the most significant problems, what is preventing people from receiving care, and what current policies are or are not accomplishing. HCC provided the first clinically-detailed, national estimates of adherence with practice guidelines for two major ADM disorders, as well as the first national estimates of disparities in quality of ADM care.

Current status: HCC1 (grant 030407) is completed, and HCC2 (grant 038273) is still active. We plan to field the final component of the survey, the Random-digit dialed survey, in January, and we hope to complete data collection in about 6 months. Analyses are on-going.