From profession-based leadership to service line management in the Veterans Health Administration: impact on mental health care.
OBJECTIVE
To investigate the impact of implementing service line organization on the delivery of mental health services.


METHODS
Survey data on the implementation of service lines and facility-level administrative data on the delivery of mental health services at 139 Department of Veterans Affairs medical centers (VAMCs), over a 6-year period, were used to examine the relationship between service line implementation and subsequent performance in 4 areas: 1) continuity of care (COC), 2) readmission after inpatient discharge, 3) emphasis on community-based mental health care (as contrasted with inpatient care), and 4) maintenance of proportionate funding for mental health care. Models were analyzed using hierarchical linear modeling techniques to control for potential autocorrelation.


RESULTS
Of 6 COC measures, 1 strongly improved in all years following service line implementation, and 3 of the 5 other measures demonstrated improvement in the first year. One of 2 readmission measures showed a decline in the first year after service line implementation. Service line implementation was associated with only 1 indicator of increased emphasis on community-based mental health care (and only in the first year), whereas 3 of the 4 other measures suggested a decline in such emphasis. Lastly, although there were increases in per capita mental health expenditures 3 or more years after service line implementation, 2 related measures indicated that service line implementation was associated with a decline in mental health expenditures relative to nonmental health services.


CONCLUSIONS
Service line implementation was associated with significant, although predominantly short-term, improvement in patient level variables such as continuity of care and hospital readmission, but less so with regard to institutional measures addressing emphasis on outpatient care and maintaining proportionate funding of mental health services.
Greenberg
Greg A
GA
Northeast Program Evaluation Center, VAMC West Haven, Connecticut 06516, USA. Greenberg@biomed.med.yale.edu
Rosenheck
Robert A
RA
Charns
Martin P
MP
D003156:Community Mental Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D016014:Linear Models; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011357:Product Line Management; D015397:Program Evaluation; D014481:United States; D014493:United States Department of Veterans Affairs