Continuity of Care After Inpatient Discharge of Patients With Schizophrenia in the Medicaid Program: A Retrospective Longitudinal Cohort Analysis

被引:59
作者
Olfson, Mark [1 ]
Marcus, Steven C. [2 ,3 ]
Doshi, Jalpa A. [4 ,5 ]
机构
[1] Columbia Univ, Dept Psychiat, New York State Psychiat Inst, Coll Phys & Surg, New York, NY 10032 USA
[2] Univ Penn, Ctr Hlth Equ Res & Promot, Philadelphia Vet Affairs Med Ctr, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Social Policy & Practice, Philadelphia, PA 19104 USA
[4] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA
[5] Univ Penn, Sch Med, Div Gen Internal Med, Philadelphia, PA 19104 USA
关键词
MENTAL-HEALTH-CARE; FOLLOW-UP; PREDICTORS; REHOSPITALIZATION; APPOINTMENTS; RECIDIVISM; STRATEGIES; PATTERNS; RISK;
D O I
10.4088/JCP.10m05969yel
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
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 pread-mission 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, 063-0.75) 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. J Clin, Psychiatry 2010, 71(7):831-838 ea (C) Copyright 2010 Physicians Postgraduate Press, Inc
引用
收藏
页码:831 / 838
页数:8
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