Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders

Objectives: This study identified patient-, hospital-, and community-level factors associated with timely follow-up care following psychiatric hospitalization for children and adolescents with mood disorders. Methods: The patients were 7,826 youths (ages six to 17) admitted to psychiatric hospitals with a primary diagnosis of mood disorder (July 2009-November 2010). Outcome variables were defined as one or more mental health visits within seven days and 30 days of psychiatric hospitalization. Predictor variables included patient-, hospital-, and community-level factors obtained from Medicaid claim files from four states (California, Florida, Maryland, and Ohio), the American Hospital Association annual survey, and the Area Resource File. Multilevel modeling was used to assess the association between patient-, hospital-, and community-level factors and receipt of follow-up care. Results: Following discharge, an outpatient mental health visit was obtained by 48.9% of children and adolescents within seven days and by 69.2% of children and adolescents within 30 days. Positive predictors of follow-up at both seven and 30 days included prior outpatient mental health care, foster care, psychiatric comorbidity, care in teaching hospitals and psychiatric hospitals, and residence in counties with more child and adolescent psychiatrists. Negative predictors included older age, black race, care in hospitals with higher levels of Medicaid penetration, and substance use disorders. Conclusions: One in three youths did not receive mental health follow-up in the 30 days after psychiatric hospitalization. Linkage to follow-up care appears to be complex and multi-determined. Study findings underscored the need for quality improvement interventions targeting vulnerable populations and promoting successful transitions from inpatient to outpatient care.