Stanley Xu, PhD

Phone: 303.636.3140
E-mail: Stan.Xu@kp.org

WICHE Rural Mental Health Research Center

Completed Projects

Identifying Stakeholders to Pay for Enhanced Depression Treatment in Rural Populations, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Mental health
The goal of this project is to identify stakeholders who economically benefit when rural patients receive enhanced depression treatment, which will, in turn, encourage health plans to provide enhanced depression treatment to their rural enrollees without raising premiums.

Publications

• Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
  Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topics: Mental health, Rural statistics and demographics
  Date: 09 / 2005
  Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
• Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 09 / 2005
  Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
• Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Citation: Journal of Rural Health, 22(4), 343-350
  Date: 2006
  Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
• Preventing Hospitalization in Depressed Rural Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 09 / 2005
  The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request.
• Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison
  Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 2005
  
• Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
  Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773
  Date: 2006
  Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.