Continuity of care after inpatient discharge of patients with schizophrenia in the Medicaid program: a retrospective longitudinal cohort analysis.

Abstract

OBJECTIVE:

This study seeks to identify patient, facility, county, and state policy factors associated with timely schizophrenia-related outpatient treatment following hospital discharge.

METHOD:

A retrospective longitudinal cohort analysis was performed of 2003 national Medicaid claims data supplemented with the American Hospital Association facility survey, the Area Resource File, and a Substance Abuse and Mental Health Services Administration Medicaid policy report. The analysis focuses on treatment episodes of adults, aged 20 to 63 years, who received inpatient care for ICD-9-CM-diagnosed schizophrenia (59,567 total treatment episodes). Rate and adjusted odds ratio (AOR) of schizophrenia-related outpatient visits within 7 days and 30 days following hospital discharge are assessed.

RESULTS:

Of the 59,567 hospital discharges, 41.7% received schizophrenia-related outpatient visits in 7 days and 59.3% in 30 days following hospital discharge. The adjusted odds of 30-day follow-up outpatient visits were significantly related to preadmission outpatient mental health visits (AOR = 3.72; 99% CI, 3.44-4.03), depot (AOR = 2.83; 99% CI, 2.53-3.18) or oral (AOR = 1.73; 99% CI, 1.62-1.84) antipsychotics as compared with no antipsychotics, and absence of a substance use disorder diagnosis (AOR = 1.35; 99% CI, 1.25-1.45). General hospital as compared with a psychiatric hospital treatment (AOR = 1.32; 99% CI, 1.14-1.54) and patient residence in a county with a larger number of psychiatrists per capita (AOR = 1.27; 99% CI, 1.08-1.50) were related to receiving follow-up outpatient visits. By contrast, residence in a county with a high poverty rate (AOR = 0.60; 99% CI, 0.54-0.67) and treatment in a state with prior authorization requirements for < 12 annual outpatient visits (AOR = 0.69; 99% CI, 0.63-0.75) reduced the odds of follow-up care.

CONCLUSIONS:

Patient characteristics, clinical management, geographical resource availability, and the mental health policy environment all appear to shape access to care following hospital discharge in the community treatment of adult schizophrenia.

• Authors: Mark Olfson, Steven C Marcus, Jalpa A Doshi
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 71 Issue 7 Pg. 831-8 (Jul 2010) ISSN: 1555-2101 [Electronic] United States
• PMID: 20441730 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: (c) Copyright 2010 Physicians Postgraduate Press, Inc.

Chemical References

• Antipsychotic Agents
• Delayed-Action Preparations

Topics

• Administration, Oral
• Adult
• Antipsychotic Agents (administration & dosage)
• Cohort Studies
• Continuity of Patient Care (statistics & numerical data)
• Delayed-Action Preparations
• Female
• Health Services Accessibility (statistics & numerical data)
• Humans
• Injections, Intramuscular
• Insurance Coverage (statistics & numerical data)
• Longitudinal Studies
• Male
• Medicaid (statistics & numerical data)
• Middle Aged
• Outpatient Clinics, Hospital (statistics & numerical data)
• Patient Discharge (statistics & numerical data)
• Patient Dropouts (psychology, statistics & numerical data)
• Patient Readmission (statistics & numerical data)
• Quality Assurance, Health Care (statistics & numerical data)
• Referral and Consultation (statistics & numerical data)
• Retrospective Studies
• Schizophrenia (drug therapy, epidemiology)
• Schizophrenic Psychology
• Secondary Prevention
• United States
• Young Adult