Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care

Factors Associated with the Receipt of Follow-Up Care Among Medicare Beneficiaries Discharged from Inpatient Psychiatric Facilities

This study examined the extent to which facility characteristics, discharge practices, and the availability of outpatient mental health care are associated with receiving follow-up care within 7 days of discharge from an inpatient psychiatric facility among Medicare beneficiaries. The study merged 2018 National Mental Health Services Survey data with 2018 Inpatient Psychiatric Facility Quality Reporting program data representing 1147 inpatient psychiatric facilities. Results from logistic regression analyses indicated that inpatient facilities operated by private for-profit organizations and public agencies had lower odds of achieving high performance on a measure that assessed if Medicare beneficiaries received follow-up care within 7 days of discharge relative to private nonprofit facilities; follow-up rates were inversely associated with the proportion of involuntarily committed patients at the facility. Follow-up rates were not associated with other facility characteristics, discharge practices, the availability of outpatient care at the location of the inpatient facility, or the density of outpatient mental health providers in the community. Improving follow-up care for Medicare beneficiaries could target for-profit and public hospitals and those that serve a high proportion of individuals involuntarily committed to inpatient care.

Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization

OBJECTIVE

This study used an ecosocial perspective to examine ethnoracial disparities in timely outpatient follow-up care after psychiatric hospitalization in a cohort of Medicaid recipients.

METHODS

This retrospective analysis used 2012-2013 New York State Medicaid claims data for 17,488 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. Claims data were linked to other administrative data sets capturing key social conditions and determinants of mental health for non-Latinx White (White hereafter), non-Latinx Black (Black), Latinx, non-Latinx Asian/Pacific Islander (Asian/Pacific Islander), non-Latinx American Indian or Native Alaskan (American Indian or Native Alaskan), and other ethnoracial groups. Regression models were used to estimate the variations in disparities in timely follow-up care that were attributable to community, organization (i.e., hospital), and individual patient characteristics.

RESULTS

Overall, 60.1% of patients attended an outpatient mental health visit within 30 days of discharge. Compared with the rate for White patients, the attendance rates were 9.5 percentage points lower for Black patients and 7.8 percentage points higher for Asian/Pacific Islander patients. No significant difference in attendance rates was found between Latinx and White patients. Community factors, specifically urban versus rural classification and county poverty status, accounted for the greatest variation in timely follow-up care in all comparisons.

CONCLUSIONS

Efforts to increase connection to outpatient mental health follow-up care after psychiatric hospitalization should incorporate cultural and structural competencies to address social conditions and determinants of mental health that underly ethnoracial disparities.

The Effectiveness of Discharge Planning for Psychiatric Inpatients With Varying Levels of Preadmission Engagement in Care

OBJECTIVE

This study examined the extent to which prehospital treatment engagement is related to posthospital follow-up treatment among psychiatric inpatients and whether the effects of inpatient discharge planning on posthospital follow-up treatment vary by level of pretreatment engagement in care.

METHODS

New York State Medicaid and other administrative databases were used to examine service use by 18,793 adult patients discharged to the community after inpatient psychiatric care in 2012-2013. Outcomes included attending an outpatient mental health service within 7 days and within 30 days after discharge. The sample was stratified by whether patients had high, partial, low, or no engagement in outpatient psychiatric services in the 6 months before admission.

RESULTS

Scheduling an outpatient appointment as part of the patient's discharge plan was significantly associated with attending outpatient psychiatric appointments, regardless of the patient's level of engagement in care before admission. The differences were most pronounced for patients who had not received any outpatient care in the 6 months before admission. When an appointment was scheduled, these patients were three times more likely to follow up with care within 7 days and more than twice as likely to follow up within 30 days than were patients without a scheduled appointment.

CONCLUSIONS

The likelihood of psychiatric inpatients following up with outpatient psychiatric care was directly related to their level of outpatient care engagement before hospital admission. Even among those who had not been engaged in outpatient care, inpatient discharge planning was associated with a greater likelihood of receiving follow-up outpatient care.