Predictive models and the effectiveness of strategies for improving outpatient follow-up under managed care.
OBJECTIVE
This study tested the accuracy of models for predicting rehospitalization in a managed behavioral health organization and tested the effectiveness of different care management strategies for enhancing outpatient treatment follow-up.


METHODS
In a controlled study, patients with an inpatient mental health or substance use admission received one of three types of care management, distinguished by the level of care managers' involvement in discharge planning and postdischarge outreach: usual (N=31), enhanced (N=94), and intensive (N=74). The groups were compared with each other and with a cohort admitted in the year before the study that received usual care management (N=192) to determine whether differences existed in time to outpatient follow-up, amount of postdischarge care, and rehospitalization at 30, 60, and 180 days.


RESULTS
No differences between groups were found. The majority of patients (69 percent) received outpatient care within 30 days of discharge. Prediction models using logistic regression suggested that the number of clinical and sociodemographic risk factors identified by care managers was related to the rate of rehospitalization at 60 and 180 days. Patients authorized to receive intermediate care (partial hospitalization or residential care) and those who failed to attend intermediate care if it was authorized were more likely than other patients to be rehospitalized at 30, 60, and 180 days.


CONCLUSIONS
Outpatient follow-up after psychiatric hospitalization did not improve with increasingly intensive discharge planning and outreach. Improvement in prediction of risk of rehospitalization may increase opportunities to provide intensive interventions for difficult-to-engage patients.
Cuffel
Brian J
BJ
United Behavioral Health, San Francisco, California 94105, USA. brian_cuffel@uhc.com
Held
Martin
M
Goldman
William
W
D000328:Adult; D000553:Ambulatory Care / Q000523:psychology*; D001524:Behavioral Medicine / Q000458:organization & administration*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D001523:Mental Disorders / Q000523:psychology*; D017146:Models, Organizational; D010346:Patient Care Management / Q000458:organization & administration*; D010359:Patient Readmission; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000523:psychology*; D013997:Time Factors