Preadmission care as a new mental health performance indicator.
OBJECTIVE
This study examined the relationship between receipt of preadmission outpatient care during the month before an episode of hospitalization and the patients' subsequent treatment.


METHODS
A total of 37,852 psychiatric inpatients who were discharged from 122 Veterans Affairs medical centers between October 1, 1997, and March 31, 1998, were studied. Linear and logistic regression were used to examine the relationship between receipt of preadmission outpatient care and length of hospital stay, use of postdischarge aftercare, and readmission.


RESULTS
Having at least one outpatient visit in the month before admission was associated with a significantly shorter inpatient stay (16 days compared with 26 days, a difference of more than 60 percent) and with significantly greater use of postdischarge aftercare (odds ratio=1.83). However, the number of outpatient visits beyond one visit in the month before admission did not increase the effect on length of stay. These effects were strongest among patients with schizophrenia.


CONCLUSIONS
Patients who have received outpatient care before hospital admission have shorter hospital stays and are more likely to use postdischarge aftercare than those who have not received outpatient care in the month before admission. Receipt of preadmission care itself rather than the intensity of such care seems to be the greatest predictor of length of stay.
Dausey
David J
DJ
Northeast Program Evaluation Center, Department of Veterans Affairs, West Haven, Connecticut, USA. david.dausey@yale.edu
Rosenheck
Robert A
RA
Lehman
Anthony F
AF
D000553:Ambulatory Care / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013997:Time Factors