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

Mark Olfson, MD, MPH; Steven C. Marcus, PhD; and Jalpa A. Doshi, PhD

Published: April 20, 2010

Article 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.

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 (mo49@columbia.edu).

Volume: 71

Quick Links: Integrated Care , Patient Care

Continue Reading…

Subscribe to read the entire article

$40.00

Buy this Article as a PDF

Sign-up to stay
up-to-date today!

SUBSCRIBE

Already registered? Sign In

Original Research

Frontothalamic Circuit Abnormalities in Patients With Bipolar Depression and Suicide Attempts

To identify potential markers for suicide risk, this fMRI study looked at neural activity in bipolar depression...

Read More...