IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0249007.html
   My bibliography  Save this article

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

Author

Listed:
  • Michael A Ruderman
  • Bo Kim
  • Kelly Stolzmann
  • Samantha Connolly
  • Christopher J Miller
  • Mark S Bauer

Abstract

Background: Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization. Rationale: Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention. Objectives: (i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics. Methods: Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect. Results: The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51–0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15–7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41–0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31–0.86). Conclusion: Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.

Suggested Citation

  • Michael A Ruderman & Bo Kim & Kelly Stolzmann & Samantha Connolly & Christopher J Miller & Mark S Bauer, 2021. "Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-17, March.
    • Handle: RePEc:plo:pone00:0249007
    DOI: 10.1371/journal.pone.0249007
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249007
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0249007&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0249007?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. van Buuren, Stef & Groothuis-Oudshoorn, Karin, 2011. "mice: Multivariate Imputation by Chained Equations in R," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 45(i03).
    2. Gandrud, Christopher, 2015. "simPH: An R Package for Illustrating Estimates from Cox Proportional Hazard Models Including for Interactive and Nonlinear Effects," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 65(i03).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Noémi Kreif & Richard Grieve & Iván Díaz & David Harrison, 2015. "Evaluation of the Effect of a Continuous Treatment: A Machine Learning Approach with an Application to Treatment for Traumatic Brain Injury," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1213-1228, September.
    2. Abhilash Bandam & Eedris Busari & Chloi Syranidou & Jochen Linssen & Detlef Stolten, 2022. "Classification of Building Types in Germany: A Data-Driven Modeling Approach," Data, MDPI, vol. 7(4), pages 1-23, April.
    3. Boonstra Philip S. & Little Roderick J.A. & West Brady T. & Andridge Rebecca R. & Alvarado-Leiton Fernanda, 2021. "A Simulation Study of Diagnostics for Selection Bias," Journal of Official Statistics, Sciendo, vol. 37(3), pages 751-769, September.
    4. Christopher J Greenwood & George J Youssef & Primrose Letcher & Jacqui A Macdonald & Lauryn J Hagg & Ann Sanson & Jenn Mcintosh & Delyse M Hutchinson & John W Toumbourou & Matthew Fuller-Tyszkiewicz &, 2020. "A comparison of penalised regression methods for informing the selection of predictive markers," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-14, November.
    5. Liangyuan Hu & Lihua Li, 2022. "Using Tree-Based Machine Learning for Health Studies: Literature Review and Case Series," IJERPH, MDPI, vol. 19(23), pages 1-13, December.
    6. Norah Alyabs & Sy Han Chiou, 2022. "The Missing Indicator Approach for Accelerated Failure Time Model with Covariates Subject to Limits of Detection," Stats, MDPI, vol. 5(2), pages 1-13, May.
    7. Feldkircher, Martin, 2014. "The determinants of vulnerability to the global financial crisis 2008 to 2009: Credit growth and other sources of risk," Journal of International Money and Finance, Elsevier, vol. 43(C), pages 19-49.
    8. Eunsil Seok & Akhgar Ghassabian & Yuyan Wang & Mengling Liu, 2024. "Statistical Methods for Modeling Exposure Variables Subject to Limit of Detection," Statistics in Biosciences, Springer;International Chinese Statistical Association, vol. 16(2), pages 435-458, July.
    9. Ida Kubiszewski & Kenneth Mulder & Diane Jarvis & Robert Costanza, 2022. "Toward better measurement of sustainable development and wellbeing: A small number of SDG indicators reliably predict life satisfaction," Sustainable Development, John Wiley & Sons, Ltd., vol. 30(1), pages 139-148, February.
    10. Georges Steffgen & Philipp E. Sischka & Martha Fernandez de Henestrosa, 2020. "The Quality of Work Index and the Quality of Employment Index: A Multidimensional Approach of Job Quality and Its Links to Well-Being at Work," IJERPH, MDPI, vol. 17(21), pages 1-31, October.
    11. Christopher Kath & Florian Ziel, 2018. "The value of forecasts: Quantifying the economic gains of accurate quarter-hourly electricity price forecasts," Papers 1811.08604, arXiv.org.
    12. Esef Hakan Toytok & Sungur Gürel, 2019. "Does Project Children’s University Increase Academic Self-Efficacy in 6th Graders? A Weak Experimental Design," Sustainability, MDPI, vol. 11(3), pages 1-12, February.
    13. J M van Niekerk & M C Vos & A Stein & L M A Braakman-Jansen & A F Voor in ‘t holt & J E W C van Gemert-Pijnen, 2020. "Risk factors for surgical site infections using a data-driven approach," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-14, October.
    14. Joost R. Ginkel, 2020. "Standardized Regression Coefficients and Newly Proposed Estimators for $${R}^{{2}}$$R2 in Multiply Imputed Data," Psychometrika, Springer;The Psychometric Society, vol. 85(1), pages 185-205, March.
    15. Lara Jehi & Xinge Ji & Alex Milinovich & Serpil Erzurum & Amy Merlino & Steve Gordon & James B Young & Michael W Kattan, 2020. "Development and validation of a model for individualized prediction of hospitalization risk in 4,536 patients with COVID-19," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-15, August.
    16. Matthew Carli & Mary H. Ward & Catherine Metayer & David C. Wheeler, 2022. "Imputation of Below Detection Limit Missing Data in Chemical Mixture Analysis with Bayesian Group Index Regression," IJERPH, MDPI, vol. 19(3), pages 1-17, January.
    17. Gerko Vink & Laurence E. Frank & Jeroen Pannekoek & Stef Buuren, 2014. "Predictive mean matching imputation of semicontinuous variables," Statistica Neerlandica, Netherlands Society for Statistics and Operations Research, vol. 68(1), pages 61-90, February.
    18. Tsai, Tsung-Han, 2016. "A Bayesian Approach to Dynamic Panel Models with Endogenous Rarely Changing Variables," Political Science Research and Methods, Cambridge University Press, vol. 4(3), pages 595-620, September.
    19. Henry Webel & Lili Niu & Annelaura Bach Nielsen & Marie Locard-Paulet & Matthias Mann & Lars Juhl Jensen & Simon Rasmussen, 2024. "Imputation of label-free quantitative mass spectrometry-based proteomics data using self-supervised deep learning," Nature Communications, Nature, vol. 15(1), pages 1-15, December.
    20. Debra Javeline & Tracy Kijewski-Correa & Angela Chesler, 2019. "Does it matter if you “believe” in climate change? Not for coastal home vulnerability," Climatic Change, Springer, vol. 155(4), pages 511-532, August.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0249007. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.