Continuity of Care After Inpatient Discharge of Patients With Schizophrenia in the Medicaid Program: A Retrospective Longitudinal Cohort Analysis
J Clin Psychiatry 2010;71(7):831-838
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
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.
J Clin Psychiatry 2010;71(7):831–838
Submitted: January 8, 2010; accepted March 8, 2010.
Online ahead of print: April 20, 2010 (doi:10.4088/JCP.10m05969yel).
Corresponding author: Mark Olfson, MD, MPH, Department of Psychiatry, Columbia University/ New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY 10032 (email@example.com).