Stanley Xu, PhD

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

WICHE Rural Mental Health Research Center

Completed Projects (1)

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 (13)

Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper)
Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Date: 02 / 2010
Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief)
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief)
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Research center: WICHE Center for Rural Mental Health Research
Topics: Health insurance and the uninsured, Mental health
Date: 03 / 2010
Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper)
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief)
Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Date: 05 / 2009
The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.
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.
Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers
Author(s): Scott J. Adams, Stan Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topics: Children, Mental health, Pharmacy and prescription drugs
Date: 10 / 2009
Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers.
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
Rural-Urban Differences in Depression Care (Working Paper)
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Date: 10 / 2009
Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.
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.

Topics Centers Researchers Other Resources Search		Stanley Xu, PhD Phone: 303.636.3140 E-mail: Stan.Xu@kp.org WICHE Rural Mental Health Research Center Completed Projects (1) 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 (13) Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper) Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Date: 02 / 2010 Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief) Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief) Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Research center: WICHE Center for Rural Mental Health Research Topics: Health insurance and the uninsured, Mental health Date: 03 / 2010 Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper) Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief) Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Date: 05 / 2009 The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression. 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. Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers Author(s): Scott J. Adams, Stan Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topics: Children, Mental health, Pharmacy and prescription drugs Date: 10 / 2009 Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers. 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 Rural-Urban Differences in Depression Care (Working Paper) Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Date: 10 / 2009 Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy. 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.