Susan H Busch's research while affiliated with Yale-New Haven Hospital and other places

Publications (148)

Article
Objectives: To learn how preferences and practices regarding telehealth have evolved during the COVID-19 pandemic for physicians who provide opioid use disorder (OUD) treatment. Study design: Publicly registered physicians who provide OUD treatment were surveyed on their current and retrospective use of telehealth and how their perception of tel...
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Importance: The mental health crisis lifeline 988 will begin operating July 16, 2022. In the absence of appropriately trained first responders, including crisis intervention teams (CITs), persons experiencing behavioral health crises face the risk of incarceration and even death. Objective: To assess county-level access to CIT in 2015 and 2020 a...
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Background: Criminal justice system costs in the United States have exponentially increased over the last decades, and providing health care to individuals released from incarceration is costly. To better understand how to manage costs to state budgets for those who have been incarcerated, we aimed to assess state-level costs of an enhanced primar...
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Objective: This study examined whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness. Methods: This study used responses to the 2017–2018 National Survey of ACOs (55% response rate) to measure ACO-reported use of three integrated...
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Importance: Digital breast tomosynthesis (DBT) is a breast cancer screening modality that has gained popularity in recent years. Although insurance coverage for DBT is not mandated under the Patient Protection and Affordable Care Act, several states have required coverage without cost sharing for private insurers. Objective: To evaluate the asso...
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Patients with serious mental illness often lack access to mental health support services. Whether new payment models facilitate access to these services is unknown. We conducted a national survey of accountable care organizations(ACOs) and find that fewer than 50% of ACOs surveyed reported that they have the ability to offer or refer patients to su...
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Background Broad consensus supports the use of primary care to address unmet need for mental health treatment.Objective To better understand whether primary care filled the gap when individuals were unable to access specialty mental health care.Design2018 mixed methods study with a national US internet survey (completion rate 66%) and follow-up int...
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Importance: Ten years after the Mental Health Parity and Addiction Equity Act, patients continue to report insurance-related barriers to specialty mental health care. Objectives: To assess privately insured patients' perceptions of the adequacy of their health plan's provider network (provider network includes physicians, clinicians, other healt...
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Background Digital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women.Objective To assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D)...
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Objective: This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in older psychiatric patients. Methods: Participants were Medicare-insured psychiatric inpatients age 65 or older. Patients receiving ECT were exact-matched to control subjects (in a 1:3 ratio) on age, gender, princ...
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Over the past decade, screening mammography in the US has undergone notable technological change, as digital breast tomosynthesis (DBT) has replaced 2-dimensional (2D) mammography.¹ Although DBT is more expensive than 2D mammography, DBT may generate downstream savings by reducing the number of women called back for additional imaging.² The goal of...
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Collaborative care - primary care models combining care management, consulting behavioral health clinicians, and registries to target mental health treatment - is a cost-effective depression treatment model, but little is known about uptake of collaborative care in a national setting. Alternative payment models such as accountable care organization...
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Objective: Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population. Methods: Longitudinal data on insurance status a...
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Background: Digital breast tomosynthesis (DBT) may have a higher cancer detection rate and lower recall compared to 2 D mammography for breast cancer screening. The goal of this study was to evaluate screening outcomes with DBT in a real-world cohort, and to characterize the population health impact of DBT as it is widely adopted. Methods: This...
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Background and Aims To reduce electronic cigarette use, some U.S. states and localities have added vaping restrictions to established smoke‐free indoor air laws. Yet, if smokers use e‐cigarettes to quit, such restrictions could have the unintended effect of attenuating the original smoke‐free air policy’s effects on smoking. This study estimated ch...
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Background: Breast cancer screening for women aged 40-49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs. Methods: We used Blue Cross Blue Shi...
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Background While advances in HIV prevention and treatment have changed the epidemic for gay and bisexual men, another epidemic faces this population. Gay and bisexual men represent one of the highest risk groups for depression, which potentially poses quality-of-life and public health challenges comparable to those of HIV. The present study seeks t...
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Objective: This study sought to characterize recent trends in mental health visits of adult outpatients to primary care physicians (PCPs), specialty mental health providers (SMHPs), and other providers (non-primary care physicians, specialists other than SMHPs, nurse practitioners, and physician assistants). Trends determined by degree of patients...
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Background Given the growth in dense breast notification (DBN) legislation in the United States, we examined the association between different types of DBN laws and supplemental screening behaviors among women. Methods We surveyed in March–April 2018 a nationally representative sample of women aged 40‐59 years who received a routine screening mamm...
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Mental health services are up to six times more likely than general medical services to be delivered by an out-of-network provider, in part because many psychiatrists do not accept commercial insurance. Provider directories help patients identify in-network providers, although directory information is often not accurate. We conducted a national sur...
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Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mor...
Preprint
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Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mort...
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Background Depression treatment disparities are well documented. Differing treatment preferences across social groups have been suggested as a cause of these disparities. However, existing studies of treatment preferences have been limited to individuals currently receiving clinical care, and existing measures of depression treatment preferences ha...
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Although professional society guidelines vary, most private insurance companies in the US will reimburse for the costs of mammography for women age 40 through 49 years.¹ While the clinical benefits and harms of screening women in their 40s have been widely discussed,²,3 there is limited evidence regarding the cost implications of contemporary breas...
Preprint
Full-text available
Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mort...
Preprint
Full-text available
Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mort...
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Background To date, 38 states have enacted dense breast notification (DBN) laws mandating that mammogram reports include language informing women of risks related to dense breast tissue.Objective Nationally representative survey to assess the association between residing in a state with a DBN law and women’s awareness and knowledge about breast den...
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The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits (N = 2056). Results of a logistic regression indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in co...
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105 Background: Despite ongoing debate about the effectiveness of initiating breast cancer screening at age 40, there is less attention paid to costs implications associated with the alternative screening starting ages. We assessed the annual costs of different screening strategies for privately insured women aged 40-49, as well as regional cost va...
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Objective: Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among yo...
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Major depressive disorder (MDD) affects approximately 17.3 million adults in the United States,¹ with a 12-month and lifetime prevalence of 10.4% and 20.6%, respectively.² Conducting clinical trials and developing new treatments for depression can be difficult because of spontaneous recovery rates and placebo effects.³ In addition, many patients wi...
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Objective: In 2012 Centers for Medicare and Medicaid Services (CMS) launched a multifaceted initiative aimed at reducing the unnecessary use of antipsychotic medications in nursing facilities due to evidence these medications are associated with little or uncertain benefit and substantial risk. Yet, little is known about whether efforts to reduce...
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Currently, 38 states have passed breast density notification laws. These laws vary by state, but generally require physicians to inform women when they are found to have dense breasts on mammography. Many state notifications also indicate that dense breasts can obscure abnormalities on a mammogram and are a risk factor for breast cancer. Some state...
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Although digital mammography has been widely used for breast cancer screening for more than a decade, it has imperfect sensitivity and specificity. A newer technology, digital breast tomosynthesis (DBT), may have a lower recall rate and a higher cancer detection rate than 2-dimensional mammography, although most studies of DBT were retrospective an...
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Background Health systems can be integral to addressing population health, including persons with incarceration exposure. Few studies have comprehensively integrated state-wide data to assess how the primary care system can impact criminal justice outcomes. We examined whether enhanced primary care can decrease future contact with the criminal just...
Article
Objectives: To evaluate the association of state dense breast notification (DBN) laws with use of supplemental tests and cancer diagnosis after screening mammography. Methods: We examined screening mammograms (n = 1 441 544) performed in 2014 and 2015 among privately insured women aged 40 to 59 years living in 9 US states that enacted DBN laws i...
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Introduction After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warn...
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Objective:: This study evaluated the effects of the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 on the use of outpatient and clinic-based mental health services and spending on those services. Methods:: Data came from the 2005-2013 Medical Expenditure Panel Survey. The analytic sample included adults ages 26-64 who wer...
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We estimate the impact of pension enrollment on mental well-being using China's New Rural Pension Scheme (NRPS), the largest existing pension program in the world. Since its launch in 2009, more than 400 million Chinese have enrolled in the NRPS. We first describe plausible pathways through which pension may affect mental health. We then use the na...
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Objective:: Privately insured individuals frequently use out-of-network psychiatrists. Yet, whether treatment provided by psychiatrists who do not accept private insurance differs from treatment provided by those who do has not been studied. The investigators described provider characteristics, patient characteristics, and treatment patterns among...
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The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 changed the landscape of mental health and substance use disorder coverage in the United States. The MHPAEA's comprehensiveness compared with past parity laws, including its extension of parity to plan management strategies, the so-called nonquantitative treatment limitations (NQTL)...
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Objective: The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorder...
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Background and aims: In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (re...
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Background: Policymakers frequently mandate that employers or insurers provide insurance benefits deemed to be critical to individuals' well-being. However, in the presence of private market imperfections, mandates that increase demand for a service can lead to price increases for that service, without necessarily affecting the quantity being supp...
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Low-income and minority communities are disproportionately affected by incarceration, which exacerbates health disparities. Through enhanced primary care, the Transitions Clinic Network (TCN) seeks to improve the health of people with chronic conditions who return to their communities from prison. Using TCN data, we assessed the impact of early eng...
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Background: The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is to eliminate differences in insurance coverage between behavioral health and general medical care. The law requires out-of-network mental health benefits be equivalent to out-of-network medical/surgical benefits. Insurers were concerned th...
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Objective: Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescri...
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Background Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral. Objective To evaluate the long-term outcomes at 2, 6 and 12 months following ED inte...
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Health care services for children with autism spectrum disorder are often expensive and frequently not covered under private health insurance. The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was viewed as a possible means of improving access by eliminating differences between behavioral health and medical/sur...
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To determine breast density awareness and attitudes regarding supplemental breast ultrasound screening since implementation of the nation's first breast density notification law, Connecticut Public Act 09-41. A self-administered survey was distributed at a Connecticut academic breast imaging center between February 2013 and February 2014. Women wit...
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Objectives: Out-of-network (OON) care is one area where patients might be more likely to challenge their healthcare bills due to the high out-of-pocket costs and unexpected charges related to emergency care or hospital-affiliated providers. We aimed to determine whether, and under what circumstances, patients negotiate with either insurers or prov...
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Research has shown male registered nurses (RNs) outearn their female colleagues by approximately $5,000 annually. The aim of this study was to explore differences in characteristics of female and male fulltime employed RNs, and to examine whether these differences help account for the female-male earnings gap in nursing. Specifically, the researche...
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To account for tobacco users' excess health care costs and encourage cessation, the Affordable Care Act (ACA) allowed insurers to impose a surcharge on tobacco users' premiums for plans offered on the health insurance exchanges, or Marketplaces. Low-income tax credits for Marketplace coverage were based on premiums for non-tobacco users, which mean...
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Background: Prescription opioid use disorder and overdose have risen substantially in the U.S. Primary care physicians are critical to many ongoing and proposed efforts to address the prescription opioid epidemic. Yet, little is known about their attitudes and beliefs surrounding this issue. This study aimed to determine primary care physicians' p...
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Background and aims: While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more...
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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in...
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Most individuals with substance use disorders and with mental disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. The advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented. However, less is known about c...
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Opioid-dependent patients often use the emergency department (ED) for medical care. To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief interv...
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Tobacco use is common among emergency department (ED) patients, many of whom have low income. Our objective is to study the efficacy of an intervention incorporating motivational interviewing, nicotine replacement, and quitline referral for adult smokers in an ED. This was a 2-arm randomized clinical trial conducted from October 2010 to December 20...
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Data are from the National Sample Survey of Registered Nurses (NSSRN). Ordinary least-squares regression was used for the model, which included gender (male, female), age, race (white, nonwhite), marital status (married, divorced or widowed, never married), children at home (yes, no), foreign education (yes, no), education (diploma, associate’s deg...
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Objective: Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children to remain on parental policies until age 26 as dependents. This study estimated the association between the dependent coverage provision and changes in young adults' use of hospital-based services for sub...
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Since September 2010 the Affordable Care Act (ACA) has required that insurers allow children to remain as dependents on their parents' private insurance plans until age twenty-six. Studies have shown that this provision increased coverage rates among young adults. In this article we analyze whether the provision also protected young adults from lar...
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Importance: Young adults have high levels of behavioral health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how use of hospital-based care changed after expanding insurance. OBJECTIVE To evaluate the association between health insurance coverage expansions and use of hospital-based care am...
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Background: In 2008, the US Congress enacted the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) requiring insurers to equalize private insurance coverage for mental health and substance use disorder services with coverage for general medical services. Objective: To examine the effects of MHPAEA on substan...
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Using annual cross-sectional data on over 100,000 adolescents aged 12–17, we studied academic and behavioral outcomes among those who were and were not likely affected by FDA warnings regarding the safety of antidepressants. Compared to other adolescents, adolescents with probable depression experienced a relative decline in grade point average of...