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Aileen B. Rothbard, ScD
Research Professor Emeritus

Aileen Rothbard, Sc.D., is Research Professor Emeritus in the School of Social Policy and Practice and in the Department of Psychiatry in the School of Medicine and a Senior Fellow at the Leonard Davis Institute of Health Economics (LDI) at the University of Pennsylvania. Dr. Rothbard received her academic training at the Johns Hopkins University School of Public Health in the area of Operations Research with a focus on Mental Health Service System Research.

Her major research is on the effects of federal, state and local policy on access, quality and cost of health care for vulnerable population groups. Dr. Rothbard uses a systems approach to study changes in the public mental health system for adults with severe mental illness. Her expertise is in analyzing and modeling behavioral health services, drug utilization and cost resulting from changes in policy and organizational structure of health care systems. Her research focuses on individuals with serious mental health disorders and their associated treatment and support systems.

Dr. Rothbard has conducted studies of the seriously mentally ill population that involve evaluating new treatment programs, monitoring the effects of reimbursement and management approaches on access and quality of care, adherence to medications and outcomes of new housing approaches. She has developed a longitudinal and integrated data base to use in these studies employing multiple data sources. Her modeling work has involved data envelopment analysis (DEA) techniques to identify best practices, queuing models to describe system capacity and cost effectiveness models to help in decision making. Her current studies are on how the new focus of integration and financing of health and mental health into a single system of care is effecting the quality of health care provision for individuals with serious mental and physical disorders and their medication practice patterns with respect to appropriateness and adherence to prescription drugs.

AREAS OF RESEARCH

Data Driven Decision Analysis

A large part of my research efforts over the years has involved the acquiring, combining and constructing of a substantial database on behavioral health treatment and support services for clients receiving care in the public mental health system. These data have been used to analyze and model service utilization, cost and outcomes for many studies employing decision support tools.    Using operations research approaches, I have employed Data Envelopment Analysis (DEA) to determine which programs are performing on the frontier of best practice. I have also used an innovative queuing network application, funded by NIMH, to do residential planning in mental health that deals with problems of system congestion between hospital discharge and community placement and some preliminary work on a user-friendly interface that will enable MH agencies to determine the number and level of inpatient, residential and outpatient resources they need to optimize their system. In a more patient oriented study approach, I was involved in implementing an e-prescribing system for five large Community Mental Health Centers (CMHCs) and developing an automated feedback report on patients who had missed refilling their psychotropic prescriptions. In addition, I was involved in study on a therapist feedback system in a CMHC agency that provided clinicians with information on the progress of their patients and suggestions on how to improve those outcome when they were below a set of benchmark levels constructed from a large sample.  Several other studies used Geographic Information System (GIS) techniques to identify variability in service access across different sites; identification of a seriously mentally ill population at greatest risk for HIV using a mental health status tool (Colorado Symptom Index (CSI); and  a prediction model that generated the rate of individuals with chronic mental illness using definitions proposed by NIMH and other State/Agency authorities.

Kuno E, Koizumi N, Rothbard AB., Greenwald J. (2005). A Service System Planning Model for Individuals with Serious Mental Illness. Mental Health Services Research, 7 (3), 135-143.

Connolly Gibbons MB., Kurtz JE., Thompson D, Mack RA,. Lee J., Rothbard A., Eisen SV., Gallop R, & Crits-Christoph, P. (2015). The effectiveness of clinician feedback versus usual care in the treatment of depression in the community mental health system. Journal of Consulting and Clinical Psychology.in press

Wu ES, Rothbard AB, Holtgrave D, Blank MB. (2014) Determining the Cost Savings threshold for HIV Adherence Intervention Studies for Persons with SMI and HIV. CMHJ DOI: 10.1007/s10597-014-9788-6 COMH-D-14-00131.1

Rothbard AB, Kuno E, Noll E, Hurford MO, Holtzer C, Hadley TR. (2013). Implementing an E-Prescribing system in Outpatient Mental Health Programs. Admin and Policy in MH.2013 May; 40(3).

Schinnar AP,  Kamis-Gould E, Markson, LE,  Rothbard, AB, Ramachandran N. (1993).  Organizational Determinants of Performance of Outpatient Mental Health Programs. Socio-Economic Planning Sciences, 27,209-217.

Racial Disparities

As part of examining mental health services as they relate to innovative program interventions and policy changes, it has been evident that racial disparities are prevalent in all forms of health care. Many of my studies have identified racial differences in mental health (MH) penetration rates, intensity of care, quality of care and geographic patterns of care for people enrolled in a large Medicaid (MA) program have provided clear evidence of significant differences despite insurance parity and similar benefits.  Rates of outpatient MH services have consistently been found to be significantly lower in African Americans compared to other racial groups, except Asians. They are also found to have the lowest rates of intensity or engagement in outpatient therapy when compared to other racial groups and less likely to receive a combination of therapy plus medication for depression. A ten year trend analysis of the MA population through 2013 showed that rates of use have increased for all groups but the differential has not decreased. Agencies providing services to the MA population in higher income, White areas were found to have higher quality of care indicators  than those  in  low income,  African American areas;  i.e., higher percentage of patients on atypical antipsychotic prescriptions (47% vs. 33%) and higher percentage using intensive  case  management (ICM)  Finally, a geographic (GIS) analysis showed that White clients were much more likely to select a program with a higher percentage of similar clients, even when they had to travel longer distances. This suggests that racial concordance may play a role in selection of a mental health facility. All of these studies indicate a complex combination of client and provider factors that result in less and poorer treatment for African Americans. See publications below.

Botcher K, Rothbard A, Lim S, Hadley T. 2014.Changes in Racial Disparities in Behavioral Health Penetration Rates in Philadelphia, 2003, 2008 and 2013. Evaluation Highlights Philadelphia Department of Behavioral Health.

Gibbons, MB, Rothbard AB, Farris K, Stirman SW, Thompson SM, Scott K, Heintz E, Gallop R, Crits Christophe P. (2011).  Changes in Psychotherapy Utilization among Consumers of Services for Major Depressive Disorder in the Community Mental Health System. Admin Policy Ment Health.2011 Nov;38(6):495-503.

McFarland, B.H., Stroup, T.S., Rothbard, A.B. et al. (2004). Antipsychotic Medication Use by Medicaid Recipients: Are there Racial Variations. Drug Benefit Trends,16 (4), 204-224.

Cost Comparison and Cost Offset

studies related to implementation of new mental health programs and changes in organizational structure and management of mental health systems have been an important focus of my research. Policy people want to know if the new programs are cost effective.  These studies have involved the costs of discharging long term state hospital clients into the community, the effect of managed Behavioral Health care on cost reductions and more recently whether Patient Medical Homes, as defined by the ACA, can help reduce care costs through more integrated patient care strategies for those with co-morbid chronic physical and mental health disorders. Additionally, many of my studies have focused on the cost of care of patients with mental health and HIV; those in recovery oriented versus traditional partial hospital programs, and cost effectiveness of supplemental services for substance abuse clients. The cost studies have shown mixed results. Given that new programs are often more costly initially, outcomes have to be exceedingly robust, which is generally not the case. They also take time to ramp up which means they are not operating at full capacity which compromises cost efficiency. However, comparing the traditional programs with the newer ones at a later time period is practically difficult as older programs are phased out. Costs are often skewed, especially with small intervention program sizes, making it is hard to draw valid conclusions. Better methodologies and study designs need to be developed in this important area of comparative cost analysis.

Rhodes KV, Basseyn S, Gallop R, Noll E, Rothbard A, Crits-Christophe P. 2015. Pennsylvania’s Chronic Care Initiative: Association with Reductions in Healthcare Utilization and Cost among Co-Morbid Medicaid Patients. Annals of Internal Medicine under review.

Rothbard AB, Lee S, Blank MB.  2009. Cost of Treating Seriously Mentally Ill Persons with HIV following HAART.J Ment Health Policy Econ 12,187-194.

Rothbard, A.B., Kuno, E., Hadley, T.R., Dogin, J. 2003. Psychiatric Service Use and Cost for Persons with Schizophrenia in a Medicaid Managed Care Program. JBH Services and Research, 31(1), 1-12.

Rothbard AB., Kuno, E., A.B., Schinnar, A.P., Hadley, T.R., Turk, R. Service Utilization and Cost of Community Care for Discharged State Hospital Patients: A 3-Year Follow up Study. 1999, Amer Journal Psychiatry,46 (6), 580-585.

Kraft, K., Rothbard, A.B., Hadley, T.R., McLellan, A.T., Asch, D.A. 1997.  Are Supplementary Services Provided During Methadone Maintenance Really Cost-Effective?.Amer Journal of Psychiatry, 154(9), 1214-1219

Deinstitutionalization and Community Integration

Deinstitutionalization and Community Integration for at risk persons with Mental Health disorders. My early research and publications focused on policy changes in the public mental health system associated with deinstitutionalization and the consequences on the care of the seriously mental ill population in the community setting. I looked at the patterns of care for individuals following their discharge from the state mental hospitals and examined the effects of deinstitutionalization on a large cohort of individuals leaving a sizeable State Mental Hospital over three years and again ten years later. I have continued to investigate the effectiveness of new programs in the community for this population such as supported housing and recovery models of care. I also have studied the treatment of their chronic health conditions to determine the extent of access and quality of care in community settings. The findings from my work with respect to the status of the mentally ill and their quality of life support the fact that it is better but not sufficiently well, as Richard Frank has concluded. Fragmentation between inpatient and outpatient services continues to be a problem and there is inadequate funding, housing capacity and social service supports to allow these individuals to live more satisfactorily in the community. Co-morbid substance use adds to the cycle of homelessness and early mortality. Nonetheless, there is a consensus that those with chronic mental health disorders are happier in this environment than in institutions and can manage sufficiently in the community with proper supports.

Evans A, Okeke B, Ali S, Achara-Abrahams I, Ohara T, Stevenson T, Warner N, Bolton C, Lim S, Failth J, King J, Dividson L, Poplawki P, Rothbard AB, Salzer M. (2012). Converting Partial Hospitals to Community Integrated recovery Centers. Community Ment Health J. Oct; 48(5):557-63.

Rothbard AB, Kuno, E. (2000). The Success of Deinstitutionalization Empirical Findings from Case Studies on State Hospital Closures. International Journal of Law and Psychiatry, 23 (3-4), 329-344.

Rothbard AB., Schinnar, A.P., Foley, K., Hadley, T.R., E. Kuno, (1998). A Cost Comparison of State Hospital vs Community Based Care for an Admission Population of Seriously Mentally Ill Adults, American Journal of Psychiatry, 156:6.

Schinnar AP, Kamis-Gould E, Delucia N, Rothbard AB. (1990). Organizational Determinants of Efficiency and Effectiveness in Mental Health Partial Care Programs. Health Services Research 25: 387-420.