Table 1.

Operational Definition of Major Constructs

Note: Physical comorbidity not included because it did not differ significantly between enhanced and usual care subjects, nor did it significantly predict outpatient costs over time in models that controlled for the covariates listed in Table 1.
* Similar to other studies6 of primary care mental health interventions, we did not include inpatient costs because we did not observe intervention effects on hospitalization.
Intervention costsTime costs (salary plus fringe benefits) were derived from care manager logs for patient screening, preparation for and delivery of the patient intervention, postsession record keeping, care manager-physician communication, and administrative overhead
Outpatient treatment costs*Outpatient visit costs based on patient-reported utilization were estimated using 1999 Medicare payment rates, classified by type and length: primary care physical at $35.51, primary care mental health at $55.78, specialty care psychiatrist<45 min at $64.84, specialty care psychiatrist >45 min at $95.99, specialty care other mental health provider <45 min at $59.06, specialty care other mental health provider >45 min at $90.72. Emergency department visit costs were estimated at $500 per episode. Medication costs were estimated from patient-reported utilization of prescribed psychotropic medications, priced at the lowest average generic wholesale price per medication dosage reported in the 2000 Red Book of prescription drugs. All costs reported in this manuscript (for our study and other studies) were adjusted by the Consumer Price Index to reflect year 2000 US dollars
Patient styleDefined as medical record notation by primary care physician that patient complained exclusively of physical symptoms at index visit vs ≥ 1 of the Diagnostic and Statistical Manual – III-R symptoms listed in the Appendix. Nine patients (5%) whose symptoms were difficult to categorize (weight gain/loss and abdominal distress) and who did not acknowledge any psychological distress were initially categorized as complaining of physical symptoms. Inter-rater reliability for patient style was established in the following manner: (1) 20% of the 200 index visit medical records (n = 40) were selected at random; (2) 2 reviewers independently abstracted all patient complaints from those 40 index visits; (3) 2 reviewers independently categorized those 40 patients as having any psychological vs all physical complaints, achieving an inter-rater agreement on patient complaint style of 95%, κ = 0.893; and (4) 1 reviewer categorized patient style for the remaining patients
CovariatesBaseline sociodemographic and clinical characteristics included age, minority status, insurance status, dysthymia in the previous year, panic attacks in the previous year, presence of work limitations around the house, number of bed or cutback days, emotional role functioning as measured by the SF-3611 (SF-36 Health Survey, the 36-item short form of the Medical Outcomes Study), and outpatient treatment costs for the 6 months before baseline